EACME Annual Conference, Amsterdam, Hollanda, 6 - 08 Eylül 2018, ss.99
Objectives: Patients at the end life may encounter hardships straining their physical, mental integrity. Physicians who are to provide healthcare for them may experience impasse to develop strategies how to approach the patients at the end of life. It may not be easy to make decisions for the patients to ease their pains, to increase their quality of life, and to assist them for an honourable end. This study aims to understand the problems, difficulties, experiences of physicians facing dilemmas in making decisions for the dying patients, and to explore the notion of ‘dying as dignified and comfortable as possible’ (1).
Methods: This is an ongoing qualitative study. The sample consists of physicians working in intensive care, cardiology, oncology and nephrology in different hospitals of Istanbul. Data are generated via in-depth interviews (so far nine) that focus on views and experiences regarding decision making and related problems at the end of life.
Preliminary Results and Discussion:
1.In Turkey, hospices and palliative care centers do not exist and their functions are carried out by intensive care units which are not appropriate to integrate families to the treatment processes. Hence, families have certain doubts about treatment and imminent decisions, and they experience conflicts with physicians.
2.Different specialists are convinced that the act of saying the truth about disease is the responsibility of others.
3.The lack of support for doctors: Doctors construct their communication frameworks in practice by trial and error. They are not psychologically supported in their professional experiences which have traumatic influences on them.
4.There are some codes of communication between doctors and patients’ relatives and they are unequally distributed among people from different social backgrounds.
Conclusion: For a more effective and ethically acceptable framework for end of life decisions the Turkish health system needs an organizational transformation. Governmental policies and institutions (hospitals, nursing homes) should serve the patients’ good (principle of beneficence), promote appropriate treatment and equitable access to end of life care. Resources for end of life care, which are costly and limited, should be allocated as fairly as possible among patients (2).