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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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    Back to Module 13: Cultural Issues
    Tools for Diagnosing and Mediating Cultural Misunderstandings

    Touch and Gender
    Medical Subculture
    Suffering
    Traditional Medicine
    Depression
    Body Language
    Bad News
    Fatalism
    Surgery
    Food Literacy
    Meaning of Illness
    Alternative Medicine
    Pain
    Imminent Death

    Food

    General Considerations Regarding Food

    • Medical professionals tend to regard food as nutrition
    • Food is love. Food is comfort
    • Unless there is a very good reason to restrict a diet, such as sodium and water for end-stage heart and kidney disease, patients should be allowed and encouraged to eat whatever they like
    • Bringing home cooked food to hospital should be encouraged
    • If there are food restrictions, e.g., kosher, halal, vegetarian, ask the family what to do. Do not assume that you know what is acceptable

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    When a Patient Refuses to or is Unable to Eat

    • In terminal care the patient may not be able to eat for a variety of reasons. Refusal to eat or inability to eat may signal the end of life
    • Families may become extremely anxious and demanding about feeding. They may demand intravenous or tube feeding; they may try forcibly to feed a choking dysphagic patient. They may resist the withdrawal of feeding and hydration
    • A useful metaphor is to describe how you go around the house shutting off lights as you prepare to leave on a long journey. The loved one is preparing for a long journey. One by one the systems for this life are shutting down. The loved one does not eat because s/he does not need to sustain this body anymore. If we try too hard to keep him/her here we are just preventing him/her from going on to the next place
    • If death is anticipated, a few days or even weeks of hydration and tube feeding is unlikely to change the outcome. It may comfort the family. It is important to pick your battles. This may not be the important one
        For Example
        It has been described that upper caste (Brahmin) Hindu families may withhold food from a dying family member, since the food is no longer relevant to their needs. This may be upsetting to Western Health professionals. As before, it is important to ask the purpose of practices and to be clear in your communication about prognosis of imminent death
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