Advance care planning
Everybody is free to conduct advance care planning. This means that all patients (including those not in a palliative phase) can make arrangements in relation to end of life questions or questions about whether to continue treatment in specific situations and, if applicable, write a will.
Do you want to write a will? You can do so in our hospital by consulting your attending physician or make an appointment with a nurse of the Palliative Care Support Team (09 246 27 50).
If a patient has a will, this will be recorded in their medical record.
The care that is provided by a hospital does not end when a patient can no longer recover from their illness and are approaching the end of life. A lot can still be done for patients: in medical and nursing terms, psychologically and socially and in the context of faith and spirituality. The combination of all this care at the end of life is called palliative care. Such care is also associated with important ethical decisions. At Maria Middelares General Hospital, these choices are also motivated by the hospital’s motto ‘Compassionate care’, against a background of a Christian view of life. Below, we want to communicate clearly what the patient may expect from us on this context.
Patients for whom recovery is no longer possible are surrounded with the most meticulous care at Maria Middelares General Hospital. Maria Middelares General Hospital does not have a separate Palliative Care Ward in the hospital. We integrate palliative care on every ward. During this phase of life, we want to offer humane, total care that takes account of the physical, ethical, mental, social and spiritual needs of the patients and their loved ones. Even if a (young) (small) child is involved in the farewell, we want to support the family as best we can.
Maria Middelares General Hospital encourages a palliative care culture that is based on a Christian view of life that considers the life of each person to be valuable from start to finish. Every colleague is involved in this palliative care culture. Precisely because of this vision, we respect a diversity of ethical viewpoints and we want to offer a caring response to each question about and around the end of life.
Palliative sedation and euthanasia
It is important to make a clear distinction between these two concepts.
- Palliative sedation means inducing sleep in terminal patients who suffer distress during the dying phase (pain, shortness of breath, hiccups, exhaustion, panic, etcetera) and for whom ‘normal’ medication no longer can provide enough comfort. To offer maximum comfort, sleep medication is administered, ensuring the patient is asleep and no longer experiences intolerable distress.
- Euthanasia means the act of intentionally ending life by another person than the person themselves, at their explicit request. Euthanasia is not a patient’s right. The patient may ask for it within a legally specified framework, but a physician is never obliged to comply with the request. At Maria Middelares General Hospital, the implementation of euthanasia can only be considered after all possibilities offered by palliative care have been exhausted, and for terminally ill patients with limited life expectancy (up to three months).
At Maria Middelares General Hospital, every request for euthanasia is taken seriously. The request and its motives are further explored according to a careful procedure. After that, the patient takes a final decision on whether or not he or she wants to continue the procedure. If the request for euthanasia cannot be met within our organisation, the patient receives support in the search for an alternative solution, which may involve referral.
Euthanasia requests by patients who experience intolerable suffering as a result of an irreversible physical condition but who are not expected to die in the foreseeable future, are also always taken seriously and listened to. However, euthanasia cannot be implemented at Maria Middelares General Hospital in this non-terminal context. For these patients, the physician, together with the Palliative Care Support Team, will provide a report of their findings to the GP and the (palliative) home care agency.
Euthanasia requests from patients experiencing intolerable psychological suffering will also be heard but, as an acute hospital, the Maria Middelares General Hospital does not have the structural framework to thoroughly explore and evaluate the request. In this case, patients are referred to a more suitable context to deal with this request further.
At Maria Middelares General Hospital, euthanasia is not performed for minors.
Decisions regarding the end of life are always taken in the context of a relationship of trust with the physician. The closest relatives are also involved in this. Multidisciplinary support by the Palliative Care Support Team is available to the patient and relatives during this process.
Palliative Care Support Team
This support team consists of several nurses, palliative physicians, a psychologist and a pastoral support worker. Through practical experience, specific training and frequent joint meetings, the members of the team have gained knowledge and expertise in supporting patients and their loved ones in these circumstances.
The team has weekly patient meetings and supports communication with and between patient, physician and relatives.
All inpatients, including those who are not in a palliative stage but who have questions about the end of life, can contact the Palliative Care Support Team. The attending physician remains the central point of contact, including for palliative patients.
Palliative Care physicians
Palliative Care coordinator
These team members can also be reached through a nurse on the ward.