The principles for determining when patients with end-stage cardiac disease require end-of-life care, are actually similar to those for determining prognosis of patients with advanced pulmonary disease.
Disabling Dyspnea or Chest Pain
Dyspnea or chest pain with rest or minimal exertion and can therefore classified as New York Heart Association class IV (NYHA class IV)
Ejection fraction less or equal 20%, if available
Persistent symptoms despite optimal medical management with vasodilators and dialectics, or
Inability to tolerate optimal medical management due to hypotension and/or renal failure
Hospice is an all-encompassing service available for patients with a prognosis under 6 months. Under the Medicare hospice benefit, patients eligible for hospice are greater than 65 years or receiving Medicare disability payments. At the start of care, two physicians must sign a statement certifying that the patient’s life expectancy is six months or less based on their best estimate of the patient’s medical prognosis. While hospice benefit was originally designed for Medicare recipients, most insurance providers cover hospice care for patients not eligible for Medicare. But, hospice eligibility depends on more than only a physician determining a prognosis of six months o less until death.
The word euthanasia is combination of the Greek eu= good, and thanatos = death. Literally and etymologically it therefore means “good death”. Historically and scholarly, euthanasia in the strict- and in the Dutch context the only proper- sense refers to the situation in which a doctor kills a person who is suffering “unbearably” and “hopelessly” at the latter’s explicit request (usually by administering a lethal injection)… and euthanasia is in the Netherlands reserved for killing on request. In concrete terms, euthanasia invovles injecting the patient with two types of eubstances: barbiturates to induce coma, followed by neuromuscular blockers which cause respiratory muscle paralysis. The consequent anoxia and cardiac arrest bring on immediate death.
The prevalence of pain varies by dx, stage of disease, and setting of care. Approximately 1/3 of patients with cancer experience pain at the time of diagnosis, while 2/3 with metastatic disease report pain. Less is known about the prevalence of pain in those with diagnoses other than cancer.
Pain is described by the World Health Organization as a “multidimensional phenomenon with sensory, physiological, cognitive, affective, behavioral and spiritual components.” Pain is a complex biopsychosocial phenomenon, an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in these terms. (Pain is whatever the patient says it is.)