Clinical Buddhist Chaplains in Hospice Palliative Care

Clinical Buddhist Chaplains in Hospice Palliative Care
臨床佛教宗教師在安寧緩和醫療

Humanism in terminal care

Invited speech at APHC 2015

#PPT
https://drive.google.com/file/d/0Bxrez0dTaT5MODN2Sk9rVmFSaXc/view?usp=sharing
ABSTRACT
HUMANISM IN TERMINAL CARE: Hospice Palliative Movement  in Taiwan
Rong-Chi Chen, MD, PhD, FANA
Buddhist Lotus Hospice Care Foundation, En Chu Kong Hospital

   Peaceful dying is an important wish of people and also a basic human right. Hospice palliative care (HPC) and terminal do-no-resuscitation (DNR) provide patients the opportunity of peaceful demise. Taiwan started the HPC in hospitals in 1990 and established the Hospice Palliative Care Act (a Natural Death Act) in 2000. The law gives the terminal patient the right to choose cardiopulmonary resuscitation (CPR) or DNR at the final stage of their life. This living will can be registered in the the National Health Insurance (NHI) Card to be legally followed in all hospitals. With the joint cooperation of Christian, Catholic and Buddhist NGO Foundations and different medical/nursing societies, we succeeded to promote HPC all over the country. In the past, physicians fight for lives against all the odds, promoting the false belief in the omnipotence of medical care and the triumph of man over nature. More and more people now die a painful death in the hospitals. We try to educate our people the concept of filial love in the terminal stage: “Filial duty and love should find its expression in being with the family member at the end of his life, and in encouraging the acceptance of disease, quiet life in his last days, and peaceful passing.” We tried to educate our physicians: “ Where it is unavoidable, the death of a patient is not a medical failure. Not being able to facilitate a peaceful and dignified demise is a medical failure.” We also engaged in soliciting and training of Buddhist chaplaincies to join in the HPC team with Christian and Catholic colleagues. NHI covered all the medical expenses in the hospice care. Since 2013, local governments and NHI joined to promote the hospice home care in order to let the terminal patients to have the right to die peacefully at home. Many terminal patients died in the hospitals. At the final stage, the patients fell into deep coma. Since the Glasgow Coma Scale shows the lowest point as 3, many family members fell into the false belief that there might be some hope. Thus they refuse to withdraw the futile life sustaining treatments. We have proposed a Taiwan Coma Scale to make the lowest point as 0. Hope this can shorten the dying stage of the terminal patients and further improve our quality of hospice palliative care.

References:

1.         Chen RC: 2006. Medical personnel should actively promote the concept of terminal DNR. Tzu Chi Med J 18: 155-7.
2.         Chen RC: 2009. The spirit of humanism in terminal care: Taiwan experience. Open Area Studies J 2: 7-11.
3.         Huimin Bhikshu：2012. The Role of Mindfulness in Hospice & Palliative Care in Taiwan.Taiwan J Hosp Palliat Care 17（2）：200-209.
4.         Chen CY: 2012. Clinical Buddhist chaplain based spiritual care in Taiwan. Taiwan J Hosp Palliat Care 17(3): 300-309.
5.         Chen RC: 2014. Taiwan Coma Scale : A Modified Glasgow Coma Scale. Taiwan J Hosp Palliat Care 19(2)：129-133.