TERMINAL ILLNESS/DEATH

In most sections of this book, death is not mentioned, although terminal illness can and does occur in many of the conditions described. In the Intensive Care Unit (ICU), 6% of the patients die, and this is likely the highest proportion within the hospital. However, transfer to ICU is not obligatory prior to death nor for that matter is being in hospital. If everything appropriate has been done in an attempt to diagnose and treat the child, it may well be that (s)he and the family will be more than happy for death to occur at home, provided all appropriate support measures are in place.

Hopefully, when a child dies, the possibility has been anticipated and there has been time for those close to the child to discuss the prospect of death with the patient and with members of the immediate family. As with the grieving process, an individual's concept of death and the approach and reactions to it will vary with age, culture and upbringing. However, it is safe to say that in the majority of cases, the opportunity to talk about the likelihood of death is welcomed, providing the moment is appropriate and the words are well chosen. It is often a good technique to encourage the child to ask you questions. Your perception of his or her fears may be considerably off mark, and it may well be that some reassurance that the child will not be alone and will not be allowed to be in pain is what they most want to hear.