Upholding Dignity in End-of-Life Care

This article was exclusively written for European Sting by Mr. Chima – Mpamah Milton, a fifth year medical student from Nigeria. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Each year, an estimated 56.8 million people worldwide, including 25.7 million in the last year of life, require palliative care, where only 14% of this population receives it. When we think of health care, we often imagine innovations, novel treatments that provide a definitive cure for patients, but we often overlook these strategies when it comes to those who are terminally ill. What happens when curing is no longer possible but caring still is?

Palliative Care and Hospice care focus on the comfort, care, and quality of life of individuals living with serious ailments. While the former is provided at any stage of the ailment along with curative treatments, the latter is a specific type of the former, catering to patients with a terminal illness and a life expectancy of six months or less. This type of care not only helps patients maintain an active life until death, but also supports patients’ families over the trauma experienced due to the disease and/ or death. Dr. Balfour Mount, in 1974, at The Royal Victoria Hospital of McGill University in Montreal, Canada, coined the term palliative care and first demonstrated what it meant to provide holistic care for people with chronic or life-limiting diseases and their families who were experiencing physical, psychological, social, or spiritual distress. 

Dignity in the context of end-of-life care encompasses a multitude of factors that aim to restore autonomy and respect for the patient. This involves attention to the patient’s needs and wishes regarding subsequent interventional strategies. It has been found helpful to avoid invasive and inappropriate investigations and to convey empathy in decision-making. It also aims to alleviate distress through symptom control and attention to psychosocial concerns. This would involve facilitating activities such as reading or watching television, providing choices regarding place of death, including storytelling, which helps them maintain their dignity of identity.

Often, cultural taboos and religious beliefs may pose barriers or influence how one thinks of dignity in end-of-life care. To that end, ethnic diversity among healthcare professionals is essential as it fosters understanding, trust, and equity in patient care. Integration of home-based care with focused nursing and easy access to primary health care, which is reliant on patient and family preference, has been shown to reduce the length of hospital stay and improve patients’ demeanor during the course of illness. Embedding palliative care services in universal health coverage and valuing non-professional caregivers can enhance dignity in end-of-life care

Achieving the Promise: Universal access to palliative care should be non-negotiable because for patients facing the end of life, comfort, dignity, and peace often matter than the next line of treatment. The true goal of palliative and hospice care is equal access and the preservation of dignity for every life until the very end.

About the author

Chima – Mpamah Milton is a fifth year medical student from Nigeria that is passionate about public health, surgery and health advocacy. He is affiliated with NiMSA (Nigerian Medical Students Association) and has held leadership roles as the Education and Training Officer in the Standing Committee on Sexual and Reproductive Health and Rights including HIV/AIDS (SCORA-NiMSA). Beyond academics, he is a passionate volunteer for campaigns and projects that emphasize the sustainable development goals to help provide access to better health care and enjoys films in his spare time.