ETHICAL ISSUES- CARING FOR

CAREGIVER
DR PRADEEP KULKARNI
CONSULTANT, SIMPATICO PALLIATIVE
CONNECT

SIMPATICO PALLIATIVE CONNECT

 CASE
• 60-year-old lady, Mrs. A with relapsed ovarian cancer,
with ascites and profound dyspnea, is in her terminal
stage of disease. She is in the hospital for
breathlessness.
• She has this disease progression one year after her
surgery and six months after chemotherapy.
• Her husband is a retired 65-year-old teacher with
chronic heart disease. The son and daughter stay at
distant places and can only visit occasionally.

SIMPATICO PALLIATIVE CONNECT

 CAREGIVER
FULL OF ADVICE AND CRITICISM EVERYTHING GOING TO BE FINE

SIMPATICO PALLIATIVE CONNECT

 CAREGIVER
DON’T WORRY ABOUT ME
REFUSES TO SHOW SIGNS OF STRESS

SIMPATICO PALLIATIVE CONNECT

 REASONS FOR STRESS
• Filial responsibility- she has done
• Family equity- daily/ distant
• Commitments-
– Husband- health, future, emotional strain
– Children- time, finances, family, job
• Care recipient’s autonomy- respected
• What is best decision- different
• Finances
SIMPATICO PALLIATIVE CONNECT
 REASONS FOR STRESS
Imbalance in life
•Long term care
giving creates an
imbalance in one’s
life
•Personal needs vs
patient’s needs
•Family routine vs
patient care

SIMPATICO PALLIATIVE CONNECT

 REASONS FOR STRESS
• High expectations
• Lack of control
• Unreasonable demands on self
• Role confusion

SIMPATICO PALLIATIVE CONNECT

 WHAT IS HAPPENING TO MR. A
• Long duration of care
• Nature of relationship
• Additional household responsibilities
• Finances
• His own failing health

SIMPATICO PALLIATIVE CONNECT

EMOTIONAL REACTIONS TO STRESS
Anxiety- keeps you alert Depression- mask

Anger- response Guilt-retrospective/powerless

SIMPATICO PALLIATIVE CONNECT

 SIGNS OF STRESSED CAREGIVER
• Feeling furious one minute, sad and
helpless the next- changing mood
• Snapping at everyone- irritability 
• You can’t remember the last time
you met a friend for dinner -
withdrawal
• Losing interest in activities
• Change in sleep and appetite
• Getting sick often
SIMPATICO PALLIATIVE CONNECT
 WHAT IS IN CONTROL?
• Symptom management
• Pain management
• Nursing care
• Managing everyday routine qualitatively
• To fulfill patient’s wishes
• Understanding disease and the situation
• Collecting information
• Meeting doctor/ follow up
• Diversion for patients
SIMPATICO PALLIATIVE CONNECT
 WHAT IS BEYOND CONTROL?

• Life span?
• To cure or control the disease
• Limitations of treatment
• To fulfill 100% wishes
• Unrealistic expectations

SIMPATICO PALLIATIVE CONNECT

 COPING WITH STRESS
• Information
• Respite-breaks, feelings counted
• Identify priorities
• Sharing the responsibilities
• Reserve your energy
• Find your strengths
• Ask for help
• Take the help that is offered
• Support- can say no, needs help, financial help, long
term care, join support group
SIMPATICO PALLIATIVE CONNECT
 NEED CONTINUES
• Decisions at end of life

• He/she needs to be cared even after death of care

recipient

SIMPATICO PALLIATIVE CONNECT

SIMPATICO PALLIATIVE CONNECT