Paliatívna medicína a liečba bolesti 2/2008

Some problems in pediatric thanatology

Our attitudes to death are defined by tabooing and displacing it out of life and hiding it behind the curtain in a hospital and by our generally accepted faith in present medicine omnipotence. In case of child death further our attitudes join – the death of a child is perceived to be unnatural, inappropriate and unfilled potentiality… though much more children were dying before. Accepting child´s death is emotionally tensive and dramatic. Death in particular child´s life is higly influenced by development of death perception in the course of childhood and by child perception parameters (characteristics). No less important is encountering the death of a child in course of childhood. Seriously ill, incurable or dying child generates several trouble areas – child itself, its parents, brothers and sisters, larger family (grandparents), friends, schoolmates and family friends and health workers who care for the child and family. Each of these groups has its peculiar problems to solve. In the centre is, of course, the child itself, who suffers behaviour changes and with whom the known course of Kübler-Ross stages can be modified in certain means. Also questions surrounding dying like „where“ (hospital, hospice, home), further triad „disthanasia – euthanasia – enabling to die with dignity) are of no less importace. Within the child care and conducting an adequate treatment (! „to care“ x „to cure“) together with „clinical“ treatment (incl. support treatment) rendered to the child and also to the family have arteherapy, psychotherapy, play therapy, logotherapy and others their unreplaceable position. Also further course of living after the child loss has its distinct stages, through which the bereaved have to be conducted professionally. Pediatric thanatology, comprising both newborn problems and incurable and infaust diseases up to acute and sudden death of a child, presents point of intersection of not only medical sciences and disciplines respectively.

Keywords: death during childhood, death and children, supportive care, euthanasy, dysthanasy, to let sb to die, situation in family.