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KMID : 0376719790030010458
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Seoul Journal of Psychiatry
1979 Volume.3 No. 1 p.458 ~ p.475
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Psychiatric Consultation on the Dying Patient
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Abstract
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As deaths in institutions from chronic illness are recently sharply increasing in Korea along the increase in life expectancy, psychiatrists began to face to calls for consultation on management of the dying patients in general hospital Settings, The author reviewed psycho-analytic and cultural aspects of death and dying and various clinical and research works on psychology of terminally illed patients and it s managements, done by Freud, Stekel, Klein, Eissler, Wahl, Feifel, Kubler-Ross, Weisman,etc., and 18(194)1079
introduced foreign models of medical school curriculum on the same subject comparing- with ours.
Seven model cases of consultation on the terminal patients out of the author´s five years of experience in liaison-consultation service in an university hospital in Korea were presented, and following conclusions were made :
1. Most cases were malignancy patients.
2. It was better not to make any definite policy on whether to tell or not to tell to the patients about their impending deaths, as some were psychotic after the notice while the others suffer because they were not told. Before we make decision we should evaluate their capacities to withstand against death-anxiety based on their past life history and personality make-ups. Psychiatrists should be flexible in dealing with the situations.
3. Often telling or not telling the truth about prognosis is not the primary questions.,
4. Although collaboration with the consul-tees is the most important one in dealing with the patients, not infrequently the consultants face the situation in which we have to reduce the amount of countertransference and death-anxiety in the consultees.
5. Although traditional coriental ulture is regarded as death-accepting one by some, Korean society is in midstream of rapid cultural changes in recent years, a kind of mixture of Shamanism, Buddhism, Confucianism, and Judeo-Christrianism. Sometimes psychiatrists need collaboratory work with preachers, priests and even with the shamans in dealing with fear of death in the patients.
6. As the patients frequently acquire their medical informations prematurely through unauthorized sneaky ways, it is imperative to keep the informations under strict confidentiality. Relative lack of medical ethics in these area is one of weaknesses in our medical society.
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