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One of the world’s foremost experts on the subject of palliative care, Dr. Harvey Chochinov, was the special guest speaker at the Jewish Child and Family Service’s Annual General Meeting June 8.

Always an entertaining speaker, Chochinov interspersed his talk on a very serious subject with a series of slides – often quite humourous, and several anecdotes recalling various experiences he has had in what is now a lengthy career in palliative care.
He began his address by referring to the work of the founder of the hospice movement, Cicely Saunders, who asked the basic question: “How can we best meet patients’ needs at the end of life?”
Chochinov noted the similarity between the goal of the palliative care movement with the newly-opened Canadian Museum for Human Rights: “You’re supposed to leave it feeling differently than when you enter it, just like we’re trying to make clinicians look at patients differently.”
“What would it mean to have a system of health ‘caring’,” Chochinov asked, “rather than ‘care’? Often there’s a paucity of caring.”
When patients “feel caring is present,” he suggested, they “are much more likely to be open to disclosing information” about themselves.
Chochinov noted the “correlation between “the will to live and pain”, explaining that “pain management has profound spiritual implications.”
To illustrate his point, he told the moving story of a verbal exchange he once had with well-known rights advocate Jim Doerksen. Chochinov related how he referred to Doerksen as being “wheelchair bound”.
Doerksen responded: “I’m not wheelchair bound, I’m ‘wheelchair liberated’.” Doerksen went on to call Chochinov a “TAB” which, Doerksen explained, meant “temporarily able-bodied”.
Continuing in an exposition how “language influences us”, especially when it comes to attitudes toward the elderly, Chochinov referred to what he defined as “elderspeak”: certain words or phrases which individuals dealing with the elderly often use, but which are essentially demeaning. For instance, Chochinov said, workers in institutions catering to older patients often “infantilize” elderly patients or residents of homes, using words such as “honey” or “sweetie”. As well, workers typically resort to the first person pronoun, as in “it’s time for our bath”.
As a result, Chochinov said, very often the people who are subjected to “elderspeak” respond angrily, screaming at or grabbing on to the individuals who use that type of language. Their behaviour, however, is not understood as reacting to the language; they are rather thought of as acting out.
“Dignity,” Chochinov noted, “is often compromised at the end of life.” Basic human functions, such as “bathing, dressing, and incontinence”, all  require assistance from another individual and which “are bound to affect all of us at the end of life.”
So, how can we change the attitudes of individuals who deal with those of us nearing the end of life? Chochinov offered a model of something which he labeled “dignity therapy” which, he suggested, is designed to “change the lens of the health care provider”.
What this form of therapy does, Chochinov said, is provide an “opportunity to engage patients in a therapy that will give them dignity.” Patients are offered the opportunity to speak about their lives, to have a “conversation that is recorded and transcribed and that can be given to a loved one.” The value of leaving a “legacy” is of utmost importance to many patients, he noted.
In this way, one can elevate the aspect of a patient’s “personhood”, Chochinov suggested. “What should I know about you as a person that can help me take the best care of you that I can?”

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