end of life care

Dealing with a terminal illness and nearing the end of life can be very difficult. Patients who are in the last days, months, or years of their life, may receive end-of-life care to support them. The focus of end-of-life care is on the patient’s quality of life. End-of-life care helps patients to live as comfortably as possible until they pass away and to allow them to pass away with dignity. End-of-life care involves:

medical care (for example, palliative care and pain management);
mental/emotional support;
spiritual support.

St. Maarten Medical Center (SMMC) contributes to the provision of end-of-life care with compassionate and appropriate support to its patient and their relatives.

WHEN DOES END OF LIFE CARE BEGIN?

Although it is not always possible to predict, people are considered to be approaching the end of life when they are likely to pass away within the next 12 months. This includes people whose passing is imminent, as well as people who:

have an advanced incurable illness, such as cancer, dementia, or motor neuron disease;
are generally frail and have co-existing conditions;
have existing conditions and are at risk of passing away from a sudden decline in their condition;
have a life-threatening acute condition caused by a sudden catastrophic event, such as an accident or stroke.

SHARED DECISION-MAKING: DISCUSSING END-OF-LIFE CARE WITH YOUR PHYSICIAN

Shared decision-making is important. This means that what is best for you is decided by you and/or your family and your care team at SMMC.

Your physicians will ask you about your wishes and preferences and take these into account as they work closely with you to plan your care. Although this is not always easy, it is important that you discuss your needs and wishes with your physicians as well as with your relatives. This will help avoid any misunderstandings concerning appropriate medical care in the last stages of life and ensure that your wishes are honored.

At SMMC, our social workers provide resources and assistance for our end-of-life patients at any stage in the process.

ADVANCE DIRECTIVES

Your physician will also ask if you have an Advance Directive, which is a written document stating your wishes concerning medical treatment in the event you can no longer make decisions for yourself (for example, a living will, power of attorney or Do Not Resuscitate Order). If you do not have an Advance Directive, please read the brochure “Advance Directives” for more information. We strongly encourage all patients to have an Advance Directive.

CONSENT FOR MEDICAL TREATMENT

It is the professional and ethical duty of the physician to refrain from providing treatments that are medically not or no longer needed treatments. However, even if you cannot be cured, medical treatment can still be part of End-of-life care. For example, to treat the consequences of your disease, to reduce complaints, and to extend your life.

For medical treatment, your consent is required. Even if a treatment is lifesaving or can be life-prolonging, you have the right to refuse that treatment. It is required that you are mentally competent, have been sufficiently informed and know the possible consequences of the treatment and non-treatment, and accept these.

During the process, your physician will provide sufficient guidance and care, to help lessen your suffering and to support your relatives.

HOSPICE CARE

Hospice care involves palliative care that is provided in a specialized care institution (White and Yellow Cross Care Foundation) or at home. Your physician and/or the Social Workers at SMMC can provide information and assistance regarding hospice care.

PALLIATIVE CARE: PAIN AND SYMPTOM MANAGEMENT

Palliative care is for patients dealing with a life-threatening condition or vulnerability. If you have an illness that cannot be cured, palliative care makes you as comfortable as possible by managing your pain and other distressing symptoms. Palliative care consists of medical and psychological treatment, as well as social and spiritual care.

PALLIATIVE SEDATION

Palliative sedation is applied when you have one or more untreatable symptoms of illness, which lead to unbearable suffering. Palliative sedation is the intentional lowering of your consciousness in the last phase of your life because lowering the consciousness can help with relieving suffering. Palliative sedation is not a form of euthanasia.

Your consciousness is lowered with pain-reducing drugs and you eventually pass away from natural causes. Palliative sedation will only be applied with your consent or if you have an advance directive stating who can make decisions for you regarding palliative sedation. This is part of the conversation when discussing end of life care with your physician.

EUTHANASIA AND ASSISTED SUICIDE

Euthanasia and assisted suicide are not allowed in Sint Maarten.

EMOTIONAL AND MENTAL SUPPORT

End-of-life care can also include helping to manage mental and emotional distress (for example feeling depressed or anxious). It is important to treat this emotional pain and suffering. Your physician may refer you to a counselor, to encourage conversations about your feelings. Medicine may help if the depression or anxiety is severe.

SPIRITUAL SUPPORT

SMMC recognizes and respects the religious faiths of its patients and visitors. Pastors of the island’s religious denominations can visit members of their congregations at their bedsides.

QUESTIONS?

Discuss your questions about End-of-life care with your physician. They can refer you to the right healthcare provider.

You can also contact the Social Workers of SMMC for further information and guidance. Please find below the contact information of SMMC’s Social Workers:

Christine Regis

Social Worker

Email: Christine.Regis@smmc.sx

Tel: +1 721 513-1111

Ext: 2504

Celine Carty

Social Worker

Email: Celine.Carty@smmc.sx

Tel: +1 721 543-1111

Ext: 2506