Doctor-Patient Relationship

2. DOCTOR PATIENTDOCTOR PATIENT
RELATIONSHIPRELATIONSHIP

3. INTRODUCTIONINTRODUCTION
““The duty of the doctor is toThe duty of the doctor is to
provide solace. It is for the GODprovide solace. It is for the GOD
ALMIGHTY to cure the illness”.ALMIGHTY to cure the illness”.
((Hadis-e-Qudsi).Hadis-e-Qudsi).

4. ““Each person who is admitted to a hospitalEach person who is admitted to a hospital
brings with him not only a physical illnessbrings with him not only a physical illness
but also a definite mental set that willbut also a definite mental set that will
influence both the manner in which heinfluence both the manner in which he
assumes his role as a patient and theassumes his role as a patient and the
course of his hospitalization”.course of his hospitalization”.
Robinson,1984Robinson,1984

5. OBJECTIVESOBJECTIVES
 Improves careImproves care
 Improves your clinical skillsImproves your clinical skills
 Fosters participation in treatmentFosters participation in treatment
 Facilitates holistic approach to careFacilitates holistic approach to care

6. OUTLINE OF LECTUREOUTLINE OF LECTURE
1.1. Clarification of concepts in doctor-patientClarification of concepts in doctor-patient
relationshiprelationship
2.2. Biopsychosocial model of therapyBiopsychosocial model of therapy
3.3. Interview methodology and environmentInterview methodology and environment
4.4. Communication/interaction and counselingCommunication/interaction and counseling
5.5. Medical ethicsMedical ethics
6.6. Islamic oath for practice of medicineIslamic oath for practice of medicine
7.7. Hippocratic OathHippocratic Oath
8.8. The dying person’s bill of rightsThe dying person’s bill of rights

7. RAPPORTRAPPORT
 Spontaneous and conscious feelingSpontaneous and conscious feeling
of harmonious responsiveness thatof harmonious responsiveness that
facilitates a useful therapeuticfacilitates a useful therapeutic
relationship.relationship.
 Basis of understanding and trustBasis of understanding and trust
between the therapist and the patient.between the therapist and the patient.
 Gives a feeling of acceptance and toGives a feeling of acceptance and to
share the problem with the doctor.share the problem with the doctor.

8. SPIRITUALITYSPIRITUALITY
 Gaining increased importance in everyGaining increased importance in every
society and culture both in health andsociety and culture both in health and
sickness.sickness.
 Patient’s mental and physical health isPatient’s mental and physical health is
influenced significantly by spiritual andinfluenced significantly by spiritual and
religious beliefs and commitments.religious beliefs and commitments.
 Therapists act asTherapists act as religiousreligious
counselors.counselors.

9. ILLNESS BEHAVIORILLNESS BEHAVIOR
““patient’s reaction to thepatient’s reaction to the
experience of being sick orexperience of being sick or
disabled.”disabled.”
 Synonymous toSynonymous to sick rolesick role
 Habitual modes of thinking andHabitual modes of thinking and
feelings further shape the sick role.feelings further shape the sick role.
Contd.Contd.

10.  Largely depends on patient’s pastLargely depends on patient’s past
experience, personality, attitude ofexperience, personality, attitude of
the family during sickness and thethe family during sickness and the
extent of relief from personal or socialextent of relief from personal or social
obligations due to illness.obligations due to illness.

11. TRANSFERENCE ANDTRANSFERENCE AND
COUNTERCOUNTER
TRANSFERENCETRANSFERENCE
 Origin inOrigin in PsychoanalysisPsychoanalysis..
 The views and attitudes of patientsThe views and attitudes of patients
and doctors about each other whichand doctors about each other which
may be reality orientated or based onmay be reality orientated or based on
the experiences and their relationshipthe experiences and their relationship
with parents during childhood.with parents during childhood.
Contd.Contd.

12.  Such views affect positively orSuch views affect positively or
negatively doctor patient interaction.negatively doctor patient interaction.

13. TRANSFERENCETRANSFERENCE
 A process of patient’sA process of patient’s unconsciousunconscious
attributionattribution of feelings to doctor in theof feelings to doctor in the
background of his / her emotionalbackground of his / her emotional
relationship with parents.relationship with parents.
 The patient’s behavior may beThe patient’s behavior may be
demanding, harsh, caring or evendemanding, harsh, caring or even
seductive.seductive.
Contd.Contd.

14.  Infact the transfer of past feelings toInfact the transfer of past feelings to
the doctors.the doctors.
 Encouraging transference reaction isEncouraging transference reaction is
at times an integral part ofat times an integral part of
psychotherapy.psychotherapy.

15. COUNTERCOUNTER
TRANSFERENCETRANSFERENCE
 The process by which a doctorThe process by which a doctor
unconsciously attributesunconsciously attributes his feelinghis feeling
to the patient in the background of histo the patient in the background of his
past relationshippast relationship
 It may take the form of negativeIt may take the form of negative
feelings or positive idealizing andfeelings or positive idealizing and
even eroticizing reactionseven eroticizing reactions..

16.  Doctors need to be insightful to suchDoctors need to be insightful to such
reactions and should rise above suchreactions and should rise above such
emotions for the sake of better doctoremotions for the sake of better doctor
patient interaction.patient interaction.

17. THERAPEUTIC MODELTHERAPEUTIC MODEL
 Biopsychosocial ModelBiopsychosocial Model
The concept of Biopsychosocial ModelThe concept of Biopsychosocial Model
of therapy is a relatively new conceptof therapy is a relatively new concept
since the patient is exposed to asince the patient is exposed to a
complex physical and psychologicalcomplex physical and psychological
make up during sickness. Therefore,make up during sickness. Therefore,
the psychosocial environment is likelythe psychosocial environment is likely
to influence the behavior, the outcometo influence the behavior, the outcome
and the ultimate prognosis of theand the ultimate prognosis of the
underlying physical disability.underlying physical disability.

18.  The psychological constitutionThe psychological constitution
provides an elaborate personalityprovides an elaborate personality
structure as well as the attitudes andstructure as well as the attitudes and
the reaction pattern of an individualthe reaction pattern of an individual
and his illness behavior.and his illness behavior.

19.  This behavior is also shaped byThis behavior is also shaped by
culture, the society and social supportculture, the society and social support
during times of crises.during times of crises.

20.  By understanding of this complex eraBy understanding of this complex era
of the interaction between differentof the interaction between different
biochemical, psychological and socialbiochemical, psychological and social
factors the therapist can plan anfactors the therapist can plan an
effective treatment strategy as well aseffective treatment strategy as well as
can manipulate those variety ofcan manipulate those variety of
factors in the management of thefactors in the management of the
sickness.sickness.

21.  It should be emphasized that theIt should be emphasized that the
events following sickness of theevents following sickness of the
person/relatives whether pleasant orperson/relatives whether pleasant or
unpleasant also determine the reactionunpleasant also determine the reaction
pattern of the people.pattern of the people.

22.  The knowledge of this aspect ofThe knowledge of this aspect of
clinical medicine is another foundationclinical medicine is another foundation
in doctor-patient relationship apartin doctor-patient relationship apart
from communication and interactionfrom communication and interaction
skills.skills.

23. MEDICAL INTERVIEWSMEDICAL INTERVIEWS
 Aspects of an effectiveAspects of an effective
interviewing include:interviewing include:
 Patient’s factorsPatient’s factors like personality,like personality,
character style and emotionalcharacter style and emotional
status.status.
 Clinical settingsClinical settings like interviewinglike interviewing
the patient in emergency room,the patient in emergency room,
hospital wards, out patienthospital wards, out patient
department or a psychiatric ward.department or a psychiatric ward.

24.  Frequent interruptions throughFrequent interruptions through::
 telephone callstelephone calls
 presence of an interpreterpresence of an interpreter
 note takingnote taking
 nature of patient’s problem/illnessnature of patient’s problem/illness
 interviewer’s methodologyinterviewer’s methodology
 his experience andhis experience and
 his theoretical orientation also havehis theoretical orientation also have
impact an interviewing.impact an interviewing.

25. THREE MAIN FUNCTIONSTHREE MAIN FUNCTIONS
OF A MEDICALOF A MEDICAL
INTERVIEWINTERVIEW
1.1. Determining theDetermining the
nature of the problemnature of the problem
2.2. Developing andDeveloping and
maintaining amaintaining a
therapeutic relationship.therapeutic relationship.
3.3. CommunicatingCommunicating
information andinformation and
implementing aimplementing a
treatment plan.treatment plan.

26. COMMUNICATION/COMMUNICATION/
INTERACTIONINTERACTION
a.a. Provides concise, accurate, andProvides concise, accurate, and
timely overview of client’s statementstimely overview of client’s statements
and help them to organize theirand help them to organize their
thoughtsthoughts
b.b. Helps a client to review what hasHelps a client to review what has
been saidbeen said
c.c. Stimulates a thorough exploration ofStimulates a thorough exploration of
themes that are important to the clientthemes that are important to the client

27.  You can summarize:You can summarize:
Non verbal communication,Non verbal communication,
active listening and verbalactive listening and verbal
expressions are some of the essentialexpressions are some of the essential
components of an effectivecomponents of an effective
communication.communication.

28. Q. Which of the following kinds ofQ. Which of the following kinds of
communication is most effective incommunication is most effective in
delivering information?delivering information?
a)a) VerbalVerbal
b)b) Tone of the voice and accentTone of the voice and accent
c)c) Facial expressionsFacial expressions
d)d) Eye contactEye contact

29. THERAPEUTICTHERAPEUTIC
COMMUNICATION/COMMUNICATION/
INTERACTIONSINTERACTIONS
 TherapeuticTherapeutic
interaction facilitatesinteraction facilitates
growth, development,growth, development,
maturity, improvedmaturity, improved
functioning andfunctioning and
improved coping.improved coping.

30. Social InteractionsSocial Interactions
It occurs daily as the staff greets theIt occurs daily as the staff greets the
patient with comments/questions suchpatient with comments/questions such
as;as;
“ Good Morning”.“ Good Morning”.
“ How are your Children?”.“ How are your Children?”.
“ Has anybody visited you“ Has anybody visited you
yesterday?”yesterday?”

31. Therapeutic InteractionsTherapeutic Interactions
 During this the staff helps the patientDuring this the staff helps the patient
to communicate feelings, fears,to communicate feelings, fears,
anxieties, frustrations etc. withanxieties, frustrations etc. with
comments such as;comments such as;
 ““ You look upset. Would youYou look upset. Would you
like to share your feelings withlike to share your feelings with
me? I will sit with you till theme? I will sit with you till the
pain medication takes effect”.pain medication takes effect”.

32. EFFECTIVEEFFECTIVE
COUNSELORCOUNSELOR
 Self awarenessSelf awareness
 Awareness of cultural experiencesAwareness of cultural experiences
 Empathy, genuineness and non-Empathy, genuineness and non-
judgmental attitudejudgmental attitude
 Ability to communicate and toAbility to communicate and to
understand the expectations of theunderstand the expectations of the
patientpatient

33.  Knowledge & intellectualKnowledge & intellectual
competencecompetence
 Immediacy of relationshipImmediacy of relationship
 AttractivenessAttractiveness
 HonestyHonesty
 TrustworthinessTrustworthiness

34. NON-VERBALNON-VERBAL
COMMUNICATIONCOMMUNICATION
 Non-verbal communication or bodyNon-verbal communication or body
language plays an important part inlanguage plays an important part in
the messages we relay to otherthe messages we relay to other
people.people.
 It also refers to the way in which theIt also refers to the way in which the
words are projected.words are projected.

35.  It can hinder or facilitate theIt can hinder or facilitate the
communication depending uponcommunication depending upon
the mode of delivery of the wordsthe mode of delivery of the words
and expressions of theand expressions of the
communicator.communicator.

36.  The important variables in non verbalThe important variables in non verbal
communication are:communication are:
a)a) PosturePosture
b)b) Personal spacePersonal space
c)c) Eye contactEye contact
d)d) Head nodsHead nods
e)e) Facial expressionsFacial expressions
f)f) Body movements and hand gesturesBody movements and hand gestures
g)g) Tone of voiceTone of voice

38. Breaking News Of ABreaking News Of A
Serious And A TerminalSerious And A Terminal
IllnessIllness
1.1. Plan in mind before startingPlan in mind before starting
2.2. Imparting adequate information toImparting adequate information to
the patientthe patient
a.a. Be honest and know about yourBe honest and know about your
limitations and uncertainty oflimitations and uncertainty of
diagnosisdiagnosis

39. b.b. Be warm and understandingBe warm and understanding
c.c. Use basic counseling skillsUse basic counseling skills
d.d. Be a source of support andBe a source of support and
encouragement and know that grief,encouragement and know that grief,
anger and despair are normalanger and despair are normal
e.e. Encourage questionsEncourage questions
f.f. Be prepared to spend more time withBe prepared to spend more time with
the patient for exploring alternativethe patient for exploring alternative
management strategiesmanagement strategies

40. 3.3. Environment:Environment:
i.i. What to say and when to sayWhat to say and when to say
ii.ii. Presence of other close associatesPresence of other close associates

41. How To SayHow To Say
1.1. Introduce yourself and the subject ofIntroduce yourself and the subject of
discussionsdiscussions
2.2. Feel concerned, ensure eye contactFeel concerned, ensure eye contact
and be humaneand be humane
3.3. Use simple language with warmthUse simple language with warmth
4.4. Indicate facts and ensure detailsIndicate facts and ensure details
5.5. Give sufficient time for questionsGive sufficient time for questions
and inquiriesand inquiries

42. 6.6. Allow the patient to be with relativesAllow the patient to be with relatives
for time in order to enable thefor time in order to enable the
patient to generate inner strengthpatient to generate inner strength
and supportand support
7.7. Give patient time to integrate andGive patient time to integrate and
don’t try to stop the flow of emotionsdon’t try to stop the flow of emotions
8.8. Soften the bad news with good newsSoften the bad news with good news
or at least hopeor at least hope

43.  Further Plan of ActionFurther Plan of Action
 Speak honestly and in terms of the rangeSpeak honestly and in terms of the range
of the possibilities especially when theof the possibilities especially when the
diagnosis is malignancy (cancer)diagnosis is malignancy (cancer)
 The dialogue and mutual confidenceThe dialogue and mutual confidence
should continueshould continue
 Continue instilling hopeContinue instilling hope
 Try to mobilize coping mechanisms ofTry to mobilize coping mechanisms of
the patient after sudden disclosure ofthe patient after sudden disclosure of
painful informationpainful information

44.  Participate in decision making forParticipate in decision making for
further treatmentfurther treatment
 The mechanism of denial should beThe mechanism of denial should be
owned initially because it is aowned initially because it is a
protective mechanismprotective mechanism

45.  Encourage patient to make intelligentEncourage patient to make intelligent
decisions about his/her own treatmentdecisions about his/her own treatment
 See patients’ relatives individually toSee patients’ relatives individually to
address their fears and foraddress their fears and for
mobilization of supportmobilization of support

46. Models of InteractionModels of Interaction
1.1. Paternalistic modelPaternalistic model
2.2. Informative modelInformative model
3.3. Interpretive modelInterpretive model
4.4. Deliberative modelDeliberative model

47. MEDICAL ETHICSMEDICAL ETHICS
Q. A 25-year-old man who is HIV-positiveQ. A 25-year-old man who is HIV-positive
comes to a physician’s office for treatmentcomes to a physician’s office for treatment
of a skin lesion. Because she is afraid ofof a skin lesion. Because she is afraid of
infection, the physician refuses to treat him.infection, the physician refuses to treat him.
This physician's refusal to treat the patientThis physician's refusal to treat the patient
is best described as:is best described as:
a.a. Unethical and illegalUnethical and illegal
b.b. Ethical and legalEthical and legal
c.c. Unethical but legalUnethical but legal
d.d. Ethical but illegalEthical but illegal

48. MEDICAL ETHICSMEDICAL ETHICS
 The ethical concerns of care areThe ethical concerns of care are
an integral part of medicine &an integral part of medicine &
doctor-patient relationship.doctor-patient relationship.
 A modern branch of moralA modern branch of moral
philosophy concerned with moralphilosophy concerned with moral
problems in medical practice, policyproblems in medical practice, policy
and research.and research.

49.  These also include legal issues suchThese also include legal issues such
as informed consent and termination ofas informed consent and termination of
care.care.
 Psychiatric and behavior medicinePsychiatric and behavior medicine
issues are another importantissues are another important
consideration of medical ethics.consideration of medical ethics.
 In due course issues likeIn due course issues like
E-consultations, relationship withE-consultations, relationship with
Media and pharmaceutical industry willMedia and pharmaceutical industry will
have to be considered and addressed.have to be considered and addressed.

50. Medical Ethics also include moral, legal
and religious issues related to:
Tissue transplant
Organ transplant,
IVF (Test tube babies)
Diagnostic procedures
(Amniocentesis)
Termination of pregnancy etc.

51. Q. A 16 years old male high school studentQ. A 16 years old male high school student
has an appointment with the physicianhas an appointment with the physician
because of recurrent pain abdomen forbecause of recurrent pain abdomen for
the past one month. The primarythe past one month. The primary
concern in the patient mind is:concern in the patient mind is:
a.a. ConfidentialityConfidentiality
b.b. Reassurance that the illness is notReassurance that the illness is not
seriousserious
c.c. Competence of the physicianCompetence of the physician
d.d. How to explain illness to his mates byHow to explain illness to his mates by
the patientthe patient

52. INFORMED CONSENTINFORMED CONSENT

53. CONFIDENTIALITYCONFIDENTIALITY
 It may be necessary to reassureIt may be necessary to reassure
a patient that confidentiality will bea patient that confidentiality will be
maintained except when:maintained except when:
 Information may be harmful toInformation may be harmful to
the patient or others.the patient or others.
 Patient does not intend to complyPatient does not intend to comply
with the treatment planwith the treatment plan
 Patient threatensPatient threatens
self-harm.self-harm.

54. EUTHANASIAEUTHANASIA
(Mercy Killing)(Mercy Killing)
 It is defined as a physician’s deliberateIt is defined as a physician’s deliberate
act to cause a patient death inact to cause a patient death in
hopelessly ill or injured patients.hopelessly ill or injured patients.
 Active EuthanasiaActive Euthanasia
 Passive EuthanasiaPassive Euthanasia
 Voluntary EuthanasiaVoluntary Euthanasia
 Involuntary EuthanasiaInvoluntary Euthanasia

55. ISLAMIC OATHISLAMIC OATH
““IN THE NAME OF ALLAH,IN THE NAME OF ALLAH,
MOST GRACIOUS, MOSTMOST GRACIOUS, MOST
MERVCIFUL”MERVCIFUL”
““Praise to be Allah, thePraise to be Allah, the
Sustainer of His Creation, theSustainer of His Creation, the
All-knowing. Glory be to Him,All-knowing. Glory be to Him,
the Eternal, the All-Pervading”the Eternal, the All-Pervading”

56.  ““O Allah, Thou art the onlyO Allah, Thou art the only
Healer, I serve none but thee,Healer, I serve none but thee,
and, as the instrument of Thyand, as the instrument of Thy
Will, I commit myself to Thee”Will, I commit myself to Thee”

57. I Dr------------------------- render thisI Dr------------------------- render this
Oath in Thy Holy Name and IOath in Thy Holy Name and I
undertake:undertake:
To be the instrument of Thy Will andTo be the instrument of Thy Will and
Mercy, and, in all humbleness, toMercy, and, in all humbleness, to
exercise justice, love andexercise justice, love and
compassion for all Thy Creation;compassion for all Thy Creation;

58. To extend my hand of service to oneTo extend my hand of service to one
and all, to the rich and to the poor, toand all, to the rich and to the poor, to
friend and foe alike, regardless offriend and foe alike, regardless of
race, religion or colour;race, religion or colour;
To hold human life as precious andTo hold human life as precious and
sacred, and to protect and honour itsacred, and to protect and honour it
at all times and under allat all times and under all
circumstances in accordance withcircumstances in accordance with
Thy Law;Thy Law;

59. To do my utmost to alleviate pain andTo do my utmost to alleviate pain and
misery, and to comfort and counselmisery, and to comfort and counsel
human beings in sickness and inhuman beings in sickness and in
anxiety; To respect the confidence andanxiety; To respect the confidence and
guard the secrets of all my patients;guard the secrets of all my patients;
To maintain the dignity of health care, andTo maintain the dignity of health care, and
to honour the teachers, students, andto honour the teachers, students, and
members of my profession;members of my profession;

60. To strive in the pursuit of knowledge inTo strive in the pursuit of knowledge in
Thy name for the benefit of mankind,Thy name for the benefit of mankind,
and to uphold human honour andand to uphold human honour and
dignity;dignity;
To acquire the courage to admit myTo acquire the courage to admit my
mistakes, mend my ways and tomistakes, mend my ways and to
forgive the wrongs of others;forgive the wrongs of others;

61. To be ever-conscious of my duty toTo be ever-conscious of my duty to
Allah and His Messenger (S.A.W.),Allah and His Messenger (S.A.W.),
and to follow the precepts of Islam inand to follow the precepts of Islam in
private and in public.private and in public.
““Allah grant me the strength, patienceAllah grant me the strength, patience
and dedication to adhere to thisand dedication to adhere to this
Oath at all times”Oath at all times”

62. HIPPOCRATIC OATHHIPPOCRATIC OATH
 II swear by Apollo theswear by Apollo the
physician, and Aesculapius,physician, and Aesculapius,
Hygeia and Panacea and all theHygeia and Panacea and all the
gods and goddesses, that,gods and goddesses, that,
according to my ability andaccording to my ability and
judgment, I will keep this Oathjudgment, I will keep this Oath
and this covenant.and this covenant.

63.  To reckon him who taught me this ArtTo reckon him who taught me this Art
equally dear to me as my parents, toequally dear to me as my parents, to
share my substance with him, andshare my substance with him, and
relieve his necessities if required; torelieve his necessities if required; to
look upon his offspring on the samelook upon his offspring on the same
footing as my own brothers, and tofooting as my own brothers, and to
teach them this Art, if they shall wish toteach them this Art, if they shall wish to
learn it, without fee or stipulation; andlearn it, without fee or stipulation; and
that by precept, lecture, and everythat by precept, lecture, and every
other mode of instruction,……..other mode of instruction,……..
ContdContd

64.  I will impart a knowledge of the Art toI will impart a knowledge of the Art to
my own sons, and those of mymy own sons, and those of my
teachers, and to disciples who haveteachers, and to disciples who have
signed the covenant and have takensigned the covenant and have taken
an oath according to the law ofan oath according to the law of
medicine, but no one else.medicine, but no one else.

65.  I will follow that system of regimenI will follow that system of regimen
which, according to my ability andwhich, according to my ability and
judgment, I consider for the benefit of myjudgment, I consider for the benefit of my
patients, and abstain from whatever ispatients, and abstain from whatever is
deleterious and mischievous. I will givedeleterious and mischievous. I will give
no deadly medicine to anyone if asked,no deadly medicine to anyone if asked,
nor suggest any such counsel; and in likenor suggest any such counsel; and in like
manner I will not give to a woman anmanner I will not give to a woman an
abortive remedy. With purity and withabortive remedy. With purity and with
holiness I will pass my life and practiceholiness I will pass my life and practice
my Art.my Art.

66.  I will not cut persons labouring underI will not cut persons labouring under
the stone, but will leave this to bethe stone, but will leave this to be
done by such men as aredone by such men as are
practitioners of this work. Intopractitioners of this work. Into
whatever houses I enter, I will go intowhatever houses I enter, I will go into
them for the benefit of the sick, andthem for the benefit of the sick, and
will abstain from every voluntary actwill abstain from every voluntary act
of mischief and corruption; and,of mischief and corruption; and,
further, from the seduction of femalesfurther, from the seduction of females
or males, of freemen and slaves.or males, of freemen and slaves.

67.  Whatever, in connection with myWhatever, in connection with my
professional practice, or not inprofessional practice, or not in
connection with it, I see or hear, in theconnection with it, I see or hear, in the
life of men, which ought not to belife of men, which ought not to be
spoken of abroad, I will not divulge, asspoken of abroad, I will not divulge, as
reckoning that all such should be keptreckoning that all such should be kept
secret. secret.

68. While I continue to keep this OathWhile I continue to keep this Oath
unviolated, may it be granted to me tounviolated, may it be granted to me to
enjoy life and practice of the Art,enjoy life and practice of the Art,
respected by all men, in all times. Butrespected by all men, in all times. But
should I trespass and violate thisshould I trespass and violate this
Oath, may the reverse be my lot.Oath, may the reverse be my lot.

69. Needs of the Dying PatientNeeds of the Dying Patient
 Holist (1984) statesHolist (1984) states
“families and patients“families and patients
may die too manymay die too many
things before thethings before the
disease finally takesdisease finally takes
life”.life”.

70.  Optimism, spontaneity, holidays, long –Optimism, spontaneity, holidays, long –
range planning, dreams, retirement, andrange planning, dreams, retirement, and
grandparenthood are but a few of thegrandparenthood are but a few of the
many things that die as a person and hermany things that die as a person and her
or his family live with a terminal illnessor his family live with a terminal illness..

71. The Dying Person’s Bill ofThe Dying Person’s Bill of
RightsRights
 I have the right to be treated as a livingI have the right to be treated as a living
human being until die.human being until die.
I have the right to maintain a sense ofI have the right to maintain a sense of
hopefulness however changing its focushopefulness however changing its focus
may be.may be.
I have the right to be cared for by thoseI have the right to be cared for by those
who can maintain a sense ofwho can maintain a sense of
hopefulness, however changing thishopefulness, however changing this
might be.might be.

72.  I have the right to express myI have the right to express my
feelings and emotions about myfeelings and emotions about my
approaching death in my own say.approaching death in my own say.
I have the right to expect continuingI have the right to expect continuing
medical and nursing attention evenmedical and nursing attention even
though “cure” goals must be changedthough “cure” goals must be changed
to “comfort goals”to “comfort goals”
I have the right not to die alone.I have the right not to die alone.

73. I have the right to have my questionsI have the right to have my questions
answered honestly.answered honestly.
I have the right not to be deceived.I have the right not to be deceived.
I have the right to have help from and forI have the right to have help from and for
my family in accepting my death.my family in accepting my death.
I have the right to die in peace and withI have the right to die in peace and with
dignity.dignity.

74.  I have the right to retain myI have the right to retain my
individuality and not be judged for myindividuality and not be judged for my
decision, which may be contrary todecision, which may be contrary to
beliefs or others.beliefs or others.
I have the right to discuss andI have the right to discuss and
enlarge my religious and / or spiritualenlarge my religious and / or spiritual
experiences, whatever these mayexperiences, whatever these may
mean to others.mean to others.

75.  I have the right to expect that theI have the right to expect that the
sanctity of the human body will besanctity of the human body will be
respected after death.respected after death.
I have the right to be cared for byI have the right to be cared for by
caring, sensitive, knowledgeablecaring, sensitive, knowledgeable
people who will attempt to understandpeople who will attempt to understand
my needs and will be ale to gain somemy needs and will be ale to gain some
satisfaction in helping me to face mysatisfaction in helping me to face my
death.death.

76. Image Of Doctors In TheImage Of Doctors In The
CommunityCommunity

78. CONCLUSIONCONCLUSION