Bechor Zvi Aminoff, MD, PhD
Geriatric Division, Sheba Medical Center, Tel-Hashomer, Israel
In the first reading of the Law of the Dying Patient as passed in the Knesset (2004), the definition of the dying patient reads as “the critical stage of an end stage patient who is expected to die within 14 days, where more than one essential function has crashed and who has a high level of suffering”. This definition is only a compromise with the concept of the sanctity of life, when the spirit of a human being departs this world for the next with dignity and without unnecessary suffering.
The new proposal is a new concept that relates to the high level of suffering and not to the quality of life of an end stage patient. Many hospitalized patients suffer from a poor quality of life due to cognitive and functional impairment and many other mental and social problems, but cannot be defined as dying patients. A definition of an end stage patient according to his/her suffering level would advance medicine as a whole immensely, as to date no definition of suffering exists in text books or medical literature, despite daily use of the word by the medical staff and families of patients. There is a total lack of awareness of medical personnel and society in general, that there are no tools with which to measure and diagnose the level of suffering of any dying patient. Similarly there are also no tools available to estimate the 2 week and/or six month survival period of any dying patient.
In view of the above the existing law is only a frame of reference. Our research has proven that the recently developed and published
(MSSE) scale can measure the suffering level in end-of-life of patients who are unable to communicate verbally and
could also be used as a key criterion for evaluating the survival period of dying patients. The level of suffering of an end stage dementia patient increases until the last day of life. At their last day of life our research concluded that 63% of dementia patients were at a high level of suffering, 30% at an intermediate level of suffering and only 7% died with a low level of suffering. Patients with a high level of suffering had a life span of less than a month.
We suggest that a survey is carried out in the departments of internal medicine, geriatrics and surgery as well as in nursing homes with the use of the published questionnaire, to determine statistics and assess the numbers of geriatric patients with a high level of suffering in these departments and institutions.
In our view, due to the inability of existing departments to diminish the high suffering level of end stage patients, we suggest opening special units for those patients with a one month life expectancy who will be treated according to the principles of the new Law of the Dying Patient.
Our research results were presented to the Committee for Labor, Social Services and Health for the Knesset and our suggested Amendment to the Law for the setting up of special units to treatment of dying patients in the high level of suffering will be included in the new Law.