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Friday, December 26, 2014

Finding respect in modern health care

When I was in college, I had the opportunity to work with Mother Teresa at the Home for the Dying and Destitute in Calcutta, India. The mission of the sisters was simple; love the least of these. Specifically they did this by bringing in the unwanted and abandoned at the end of life, and giving them a bed, meals if they could eat, and a place to die in the company of another.

The home was sparse by anyone’s account; an open room with a slab concrete floor lined with mats placed on the concrete 3 feet apart. The medications available were even sparser, the only real means of eliminating pain being the ability to hold someone’s hand or give a novice massage. Despite the paltry means of the place, the patients’ eyes shown with immense joy. I soon learned that the medicine we dispensed that had this powerful effect was respect.

Respect is admiration earned by abilities, achievements, or qualities. Interestingly, even with great achievements, etc. respect is not guaranteed, but is completely in the hands of the beholder. The same is inversely true; respect can be given to someone who does not deserve it.

This ability of an individual to grant or retract respect makes it all the more powerful. In Calcutta, the act of lifting someone literally from the gutter and bringing them into a shelter with a bed and food was enough to communicate respect for their person hood. How, though, do we do that here? What tangible ways can we grant respect to someone at the end of their life?

There are a plethora of ideas that come to mind; from simple things like making eye contact and listening to being attentive to personal care needs like bathing and shaving. Really though, any action you may offer depends on the concept behind respect. Respect first and foremost understands a person’s needs and prioritizes those.

In fact, the actual effort to understand what that person really needs or wants is in itself an act of respect. For example, for one patient the respectful thing to do may be to sit for an hour and visit, reminiscing on times gone by. For another, however, the respectful thing to do might be to leave, allowing them time to rest.

Respect says “I care about you enough to understand what you need and grant it, despite my own feelings.”

There is no time more difficult to show respect than over actual end of life decisions. One of the most profound ways to respect someone is by finding out how they want to die, and honoring that. If someone voices the desire to be done with medical interventions, even if those interventions can prolong their life, the respectful thing to do is not to talk the person into your views, but at that point to allow a natural death.

Respect then is many things; meeting physical needs, being kind and caring, trying to understand where someone is coming from, and ultimately honoring their decisions. You’d be amazed to find that when we grant this gift, even to the undeserving, it can be more powerful than medication.

Source: Google books Ngram Viewer
Dr. Clarkson is a hospice physician for Southwind Hospice in Pratt, KS. This post was originally published in Dr. Clarkson's End Notes column for the Pratt Tribune.  It is re-published here with the author's permission under a Creative Commons license.

Image credit: Google search

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