Abstract · The case study is about a 42-year-old breast cancer patient whom we, a general practitioner and a mental health professional, had treated in her last 18 months. In the summer of 2015, the condition of our metastatic breast cancer patient, who had been treated with her illness for nine years, deteriorated with symptoms of weight loss, vomiting, weakness, and diarrhea. Due to the nature of her illness and her condition, both her health professionals and her relatives had to consider the immanency of her death. The patient’s mental state was characterised by innate anxiety, fear, a feeling of shame and an exaggerated sense of responsibility. Further tests confirmed adrenal insufficiency. The administered steroids triggered a psychotic episode followed by regression. Reducing the dosage of the administrated steroids improved the patient’s condition. At that stage of the patient’s illness biological therapy could be started, which significantly improved the patient’s quality of life in the final period lasting about twelve months. During this period the patient was able to develop both mentally and spiritually. Unfortunately, her husband deserted her during her illness, yet she was strong enough to be able to face her death with dignity. At the terminal stage of the illness, we provided full hospice care at her home for three weeks. She passed away in peace, surrounded by her family and her beloved dogs.
This case is an example for the possibility of improving the experience of passing away with dignity even after a life full of hardships and suffering.
Abstract · In 2017, for the first time in Hungary, a nationwide research investigated prevailing wishes, opinions and knowledge related to end-of-life decisions within the adult population. The survey was conducted in a representative sample of 1100 adults over 18 years of age. Between 72.7-77% of the respondents would request symptomatic treatment at the final stage of an incurable disease. From these adults, 57.2% would prefer to die at home receiving professional care and 20.8% in inpatient hospice care. 65.1% of the respondents has heard about the possibility of refusing medical treatment, while 34.5% is aware of the availability of advance directives, but their knowledge is limited. 14.8% of those questioned would make advance directives, while 40.7% would consider making one, in order to ensure that they make their own decisions. There is an immense need for hospice-palliative care within the population. Although decision-making regarding medical treatment is widely supported, it is hampered due to a general lack of information. Development of palliative-hospice care, adaptation of international guidelines and best practices, national informative campaigns and regular researches supporting these activities would be needed to provide better care in accordance with the patients’ end-of-life wishes.
Abstract · The death of a child, at any age, is tremendous pain, emotional burden for the parents. It tends to become overwhelmingly difficult when the immediate or larger surroundings do not understand, do not want to understand the weight of the loss, thus illegitimating the parents’ grief. The aim of the study is to demonstrate what possibilities of remembrance are available in perinatal loss and grief. The focus, while giving an overview of guidelines and institutional practices, is on places of memory in cemeteries, in institutions, on self-help groups, on the possibilities offered by internet and social media pages and on ways of remembrance offered by non-profit organisation. Institutional practices and burial customs can show it clearly what communication taboo surrounds perinatal loss and the grief connected to it. The different ways of remembrance self-help groups, social media and internet sources provide however reveal that it is essential to talk about this loss, to express in different ways the grief over early loss of an expected child.
Abstract · There is an increasing number of couples participating in assisted reproduction technology (ART) procedures in Hungary. Even if right the first treatment is successful, it bears a significant level of mental strain. There are several losses attached to the infertility treatment, and to the closely repeated interventions.
In our study we aim to point at the actuality and the further options to provide adequate support for the couples participating in ART procedures, by taking a look at the current situation in Hungary, via a case study and the support needed due to the special characteristics of the ART process itself. In practice it is demonstrated that the latter and the protocol regarding ART treatment make it even more difficult to identify and acknowledge the losses accompanying the procedure and the opportunity to cope with it, exactly in the same way as we experience it in case of a perinatal loss. In order to prevent negative psychological effects and to achieve adaptive coping, mental preparation and psychological support right from the very beginning provided for the couples is a necessity- preferably realized with institutional cooperation.