Life despite death. What is the terminal phase?
The terminal state is the last stage of life for a person with a terminal illness. Although medicine no longer offers the possibility of a cure, this does not mean giving up treatment altogether. On the contrary, it is a time of special care for a person who is confronted not only with physical pain, but also with anxiety, loss of agency and loneliness. Caring for patients in the terminal phase of an illness is not about prolonging life at all costs, but about improving the quality of life - here and now.
According to the WHO definition, palliative care is an intervention aimed at alleviating suffering: whether somatic, psychological, social or spiritual. It is a holistic approach, involving not only the patient, but also their relatives. It encompasses not only symptomatic treatment, but also emotional and spiritual support, caregiver education and bereavement accompaniment. In this sense, the humanisation of care is not an add-on to standards but its core.
What does a patient feel when they know they are dying?
The awareness of impending death evokes a whole range of difficult emotions from fear, through anger and a sense of hurt, to the need for reconciliation and closeness. For a person in the terminal phase of an illness, the most important thing is often no longer the next medical procedure, but something completely different: contact with loved ones, silence, attentiveness, the opportunity to say goodbye to life with dignity.
Research shows that patients at the end of life want to be treated not as a 'medical case' but as people with a story, emotions, needs. They want to retain control over their daily lives, even if it just means choosing their wash times or being able to talk to the chaplain. Many emphasise that they struggle more with loneliness and the lack of the authentic presence of another human being than with pain.
Humanising care in this context includes respecting emotional needs, respecting intimacy, enabling contact with the family and dying with dignity - without haste, without silence, without indifference.
Small things that mean everything
Caring for the terminal patient is not about spectacular gestures. What counts is attentiveness to everyday needs and the ability to see the person in their fragility. Humanisation in practice is concrete: a hand that is held, a look that does not run away, a conversation, even if it is difficult to find the right words. It also means respecting the sick person's privacy, giving them silence when they need it, or company when they are afraid of being alone.
Physical conditions are also important. Can the patient ask for a curtain to be drawn? Are staff addressing him by name? Can he or she count on help in the toilet without feeling ashamed? These small elements of everyday life are of great importance. They are what create a sense of dignity at a time when illness takes away strength and control of the body.
Palliative care should be holistic, focusing not only on pain management, but also on psychological, spiritual and social well-being. The medical team-doctors, nurses, psychologists, pastoralists-should work together to create a safe space for the patient and his or her family. Because sometimes it is not the medication that matters most, but someone's quiet presence.
When the system fails. What makes it difficult to leave with dignity?
Although standards for palliative care are clearly defined, their implementation in Poland still faces many barriers. The number one problem is the shortage of staff - both specialist doctors and nurses with appropriate training. There is a shortage of places in hospices, especially in smaller towns. Home care, although available in theory, in practice often means loneliness for the patient and overburdening the family.
It also happens that terminal patients end up in hospital wards that are not prepared for such care. There is a lack of time, empathy and individual attention. Often there is also a lack of courage to talk about death doctors avoid the subject and patients are left alone with their fear.
An additional problem is low public awareness. Families do not know where to seek help. And yet, palliative care should not be a 'last resort'. - it is a form of treatment that can accompany the patient for weeks or months. If it were better organised and more accessible, many patients would be able to pass away more peacefully, in their own homes, among their loved ones, without pain and fear.
What really matters? Attention, presence, respect
At the end of life, everything becomes simpler and more real. What matters is no longer the next procedure, but whether someone is next to you. Whether the patient can say goodbye. Whether he or she feels that his or her needs are important, even if he or she has little time left.
In the final weeks of life, patients often ask themselves questions about meaning, about relationships, about what will be left behind. They need not only care, but also understanding. Humanising medicine is just that: being with people on their terms, without pretence, without running away from the truth.
Respect for the dying is not just a moral issue - it is an expression of our humanity. No matter how long someone will live, they deserve to be treated with dignity, tenderness and peace. This is at the heart of palliative care. And this is what really matters.