In the ’Poems’ column of our present issue we publish the poem of the Andor Gabor and Attila József price laureate poet Istvan Kemsei (1944) titled ’To Leo Tolstoy, Astapovo, Raiway Station’ from his latest volume (The Night-cap of Immanuel Kant, 2006) in which he shares eternal dilemmas related to death with us evoking tolstoian tone as well.
U.S. oncologist Dr. Kathleen Foley also begins her essay with eternal problems related to passing U like autonomy of the dying person and right to the dignity of death. As the chair of an international organization uniting all hospices in the world her main aim is to modify the culture of dying and to improve the dying patients’ quality of life. By clarifying the concepts she aims to strenghten the collaboration of the organizations struggling for the joint aim. She considers revealing the relations and attachment points - similarities and differences - between hospice and palliative care as one of the main aims of the hospice movement right now. This is - among others - attempted in the study that also provides a historical review. The high standard study also informs us that it is a problem in not only Hungary to integrate hospice care into the health care system but also in the USA, the most developed country of the world.
Our present issue is continued with the studies of three young authors in their twenties. We think it is important to raise the attention that young people who are just starting their way are interested in issues related to death, two of them led investigations on the topic among medical students.
Entrant psychologist Monika Turcsanyi was examining medical students’ fear from death and its effect on their empathetic skills. Medical students face death during pathology and anatomy practices as soon as in the first year of their studies. The aim of the study is to explore possible relationships between empathy and methods of coping with experiences related to facing death. Improvement of the methods of coping with these hard issues may add to the relationship between future doctors and their most severe patients in the long run.
Medical student Adam Vajsz examined knowledge concerning, and attitude towards euthanasia among sixty fellow medical students. In the survey he questioned knowledge on not only active and passive euthanasia but that of assisted suicide, living will and palliative care as well. Conclusion of the study is: greater emphasis should be put on communicational, ethical and legal problems during medical education at the universities since a doctor must be prepared to act in these situations. Unfortunately, not only newly graduated doctors are not completely aware of all these but often practicing physicians are also missing this knowledge.
Alexandra Kugler works as a doula and also a hospice helper thus she is present both at the beginning and at the end of life. As she writes: ’Support given to the one arriving is similar to that of given to the one passing: respesctful presence, physical-spiritual help and support to the family in both cases’. In our column ’Confessions’ she describes her experiences related to her own serious illness, the helplessness of defencelessness, the lack of helpers and feelings toward the experience of death’s closeness. This made her later help those who often have to cope with their lifes’ great events.
The ’Sources’ column contains the part dealing with death from the chapter titled Description of life and death that was first published in latin in 1623 as part of Sir Francis Bacon’s (1561-1626) Historia naturalis, the faithful translation was made by Laszlo Andras Magyar. By introducing the normal function of the human body and physiological and environmental causes leading to death, and by picturesque description of agony’s symptoms rennessaince medicine aims to answer questions on the phenomenon of life and processes of death that are hazy even for us.
This year’s first issue also contains a commendation of an exciting exhibition on the mummies found in the Whites’ Church in Vác, on the history of the troves and on the realization of the exhibition. These are introduced by two enthusiastic anthropologists, Ildiko Szikossy and Ildiko Papp, the organizers of the exhibition. The study touches upon interesting anthropologic concerns of the troves, for example on the fact that more than two-third of the mummies show the signs of tuberculosis infection but many of them might have been healed - this is implied by the buried bodies’ average age of above 60 years. The exhibition’s title is Secrets, Fates, MUMMIES and is on view in the Hungarian National History Museum.
We wish you a pleasant thrill that is a pleasant read!
To Leo Tolstoy, Astapovo, Railway Station
The past and future of palliative care. Improving end-of-life care. Why has it been so difficult? Hasting center report special report 35 (2005) (6): S42-S46
Chair of the International Association for Hospice and Palliative Care (IAHPC), Dr. Kathleen Foley reviews the most important current issues of hospice and palliative care on an international level and in her home country, the United States of America. The study clarifies some basic concepts e.g. the differences between hospice and palliative care. The author provides with a detailed analysis on the difficulties of introduction of end-of-life care and its integration into the health care system in one of the most developed countries of the world.
Medical students’ fear from death and its effect on empathy during medical education
It is unavoidable for medical students to face death that makes coping with fear of death neccessary as well. During pre-clinical years practices of pathology and anatomy are the paramount scenes of facing death. The way medical students cope with these experiences may influence their attitudes and relationship with patients. The present research was primarily aimed to explore possible relationships between empathy and methods of coping with fear from death and with experiences confronting with death. Our results show that there are coping patterns correlating with both fear from death or its some component and some component of empathy, thus their mediator role is possible. Based on the results we made a theoretical model according to which objectification and cognition as coping strategies may play a mediating role between fear from death and empathetic care or empathetic distress.
Adjudication of euthanasia among medical students
The study examines medical students’ perfection in, and attitude towards euthanasia. During the investigation I surveyed 60 students of the Faculty of Medicine, Semmelweis University using a questionnaire consisting of 12 questions. The aim was to assess to what extent the students are aware of the topic and to what extent they are prepared to the related communicational and health care difficulties.
Methods: During the survey I asked 60 students altogether, ten from each years: five girls and five boys. The selection of the students was totally random within the grades, irrespectively of scholastic record, religion, family or financial background or the profession of the parents. The results were analyzed in two groups (lower and higher grade students).
Results: Although the students receive many information related to this issue they are not completely aware of the concepts and are not prepared to these situations neither in communicational nor medical or legal point of view.
Conclusions: The universities should put more emphasis on making the students more aware of treating patients in terminal condition or other severe cases, of communication with them and - for the sake of the patients and themselves - of related knowledge.
A bifurcating road - birth and death - why I became a helper?
The author who is helping in hospice care and at deliveries self-confesses on processes and experiences that made her take part in the work of those serving at the beginning and end of life and she considers this as a calling. As almost a child she herself experienced what it is like to get close to death by means of an illness, to live through a near-death experience and has to struggle in helpless despair due to the covert communication of doctors. This milestone that meant meeting with feeling of passing in her life led her to serve as a helper in hospice care even today. Another experience, the beautiful feeling of assisting at a delivery made her recognize the similarities between the two most important events of life and prompted her to take a helper role at deliveries as well.
On DeathFRANCISCUS BACON: Historia vitae et mortis. Opera omnia. Francofurti, Schoenwetterus, 1665. 555-560.
(Translated, introduced and footnoted by: László András Magyar)
Mortui viventes docent - Death teaches those living
The exhibition Secrets, Fates, MUMMIES is open from April 8 till November 30. (2006) in the Hungarian Natural History Museum. The museum is open daily from 10:00 to 18:00. Closed on Tuesday.