gc08-9 - THE SPIRITUAL DIMENSION IN END OF LIFE CARE...

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1 8/3/08 Cassem/MGH 1 THE SPIRITUAL DIMENSION IN END OF LIFE CARE PSYCHIATRIC PERSPECTIVE ON MANAGEMENT OF SUFFERING AND LIFE ENHANCEMENT Ned H. Cassem, MD Chair, MGH Psychiatry Professor, Harvard Medical School 8/3/08 Cassem/MGH 2 NETHERLANDS: REASONS FOR REQUESTING EUTHANASIA LOSS OF DIGNITY 57% PAIN* 46% UNWORTHY DYING 46% BEING DEPENDENT ON OTHERS 33% TIRED OF LIFE 23% *PAIN AS ONLY SYMPTOM 5% Van der Maas et al, Lancet 1991; 338: 669-74.
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2 8/3/08 Cassem/MGH 3 NETHERLANDS: REASONS FOR REQUESTING EUTHANASIA THE SUFFERING THAT CAUSES REQUESTS FOR EUTHANASIA AND ASSISTED SUICIDE IS PRIMARILY PSYCHOSOCIAL AND SPIRITUAL 8/3/08 Cassem/MGH 4 COPING AT THE END OF LIFE • LIVING WITH THE DISABILITY • THE MAINTENANCE OF MORALE • THE SEARCH FOR MEANING – Avery Weisman, The Vulnerable Self
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3 8/3/08 Cassem/MGH 5 POSITIVE GOALS & MAINTENANCE OF MORALE • ERIC CASSELL: A UNIQUE LIFE LIVED IS A WORK OF ART 8/3/08 Cassem/MGH 6 THE INTERACTIVE PROCESS (TWO TEAMS) • THE PATIENT AND KEY LOVED ONES • THE CAREGIVERS
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4 8/3/08 Cassem/MGH 7 THE RESOURCES • THE PATIENT: INNER – “COPING SKILLS” – EMOTIONAL “STRENGTH” –SMARTS – “INNER LIFE” DIMENSION 8/3/08 Cassem/MGH 8 THE RESOURCES • THE PATIENT: OUTER – KEY LOVED ONES – VARIOUS GROUPS • SOCIAL, RECREATIONAL •WORK •CULTURAL • RELIGIOUS • SPIRITUAL
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5 8/3/08 Cassem/MGH 9 THE RESOURCES • THE CAREGIVER: INNER –EXPERIENCE – KNOWLEDGE: GENERAL AND SPECIALIZED – COMPASSION, EMPATHIC CAPACITY – EMOTIONAL DEPTH, MATURITY – HUMILITY 8/3/08 Cassem/MGH 10 THE RESOURCES • THE CAREGIVER: OUTER – MENTORS, CONSULTANTS –MEDLINE – THE TEAM – OWN PASSIONS, INVESTMENTS – KEY LOVED ONES – VARIOUS GROUPS
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6 8/3/08 Cassem/MGH 11 COPING WITH MEDICAL ILLNESS • LIVING WITH THE DISABILITY • THE MAINTENANCE OF MORALE • THE SEARCH FOR MEANING – Avery Weisman, The Vulnerable Self 8/3/08 Cassem/MGH 12 EMPHASIZE THE NORMAL OVER THE DISEASED POSITIVE TRAITS, VIRTUES, CONTRIBUTIONS NORMAL STYLE & PERSONALITY, CHARACTER TRAITS THE UNIQUENESS OF EACH PERSON
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7 8/3/08 Cassem/MGH 13 COPING AT THE END OF LIFE: A MULTIAXIAL APPROACH AXIS I: CLINICAL DISORDERS AXIS II: PERSONALITY DISORDERS AXIS III: GENERAL MEDICAL CONDITIONS AXIS IV: PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS AXIS V: GLOBAL FUNCTIONING 8/3/08 Cassem/MGH 14 EMPHASIZE THE NORMAL OVER THE DISEASED POSITIVE TRAITS, VIRTUES, CONTRIBUTIONS NORMAL STYLE & PERSONALITY, CHARACTER TRAITS THE UNIQUENESS OF EACH PERSON
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8/3/08 Cassem/MGH 15 PRE-AXIS I CLINICAL ISSUES DEALING WITH LOSS OF SELF (ESTEEM): DAMAGE REPAIR & RESTORATION DEALING WITH LOSS OF OTHERS: BEREAVEMENT 8/3/08 Cassem/MGH 16 SELF ESTEEM: DEFINING THE PATIENT • WHO AM I? • WHO WAS I AT THE TOP OF MY
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gc08-9 - THE SPIRITUAL DIMENSION IN END OF LIFE CARE...

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