[Terminal care--a practical guide for the physician]

In spite of the tendency to institutionalize the terminally ill patient, the decision as to where he spends his final days nevertheless remains with the patient. Should this be at home or in private surroundings, the responsibility of "death guidance' rests with the doctor/practitioner and involves assisting not only the patient, but also his next of kin. This guidance, if given meaningfully and with understanding, is invaluable to both the patient and his family. The three clinical stages leading up to the death of a patient are the prediagnostic and diagnostic phase, the stage at which the illness is established, and the regression stage. During this process, the patient also undergoes psychological changes, described as awareness, negation, rebellion, remorse, depression and finally, acceptance. When death has occurred, the doctor must indicate this to the family euphemistically and with compassion. Although the doctor's main obligation may end here, further assistance to the family will be of great help; this includes contacting the undertaker, informing the next of kin, contacting a priest if required, offering immediate medical assistance to the next of kin, laying out the deceased and reassuring the family before leaving.