Page 15 - TERMINAL DISCHARGE GUIDELINE FIRST EDITION 2023

Chapter 3
Introduction

Chapter 3 Introduction
In the recent decades, Palliative Care Medicine is an emerging
subspecialty that is gaining a lot of respect in the contemporary medical
field. WHO defines it as:

“An approach that improves the quality of life of patients and their families
who are facing problems associated with life-threatening illness. It

prevents and relieves suffering through the early identification, correct
assessment and treatment of pain and other problems, whether physical,
psychosocial, or spiritual.”

Notably, numerous patients wish to spend their final days at the comfort
of their own homes surrounded by their loved ones. This is known as
Terminal Discharge (TD), which is defined as a discharge of hospitalised

patients when death is imminent (within hours or days) and is a
fundamental component of palliative care.

Terminal discharge should only be considered when curative or life-
prolonging treatment is futile, and this is in line with Section 2 Clause No.5
in the MMA (Malaysia Medical Association) Code of Ethics which states

that:

“Where death is deemed to be imminent and where curative or life-

prolonging treatment appears to be futile, ensure that death occurs with
dignity and comfort. Such futile therapy could be withheld, withdrawn or
one may allow irreversible pathology to continue without active
resuscitation. One should always take into consideration any advance

directives and the wishes of the family in this regard.”

Many patients prefer to pass away at home and hence there is a need to
assess if this is feasible. Moreover, the caregivers will need to be identified
and should undergo Caregiver Training (CGT) to ensure that they are
competent to provide quality care to the patient at home.

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TERMINAL DISCHARGE GUIDELINE 2023