1. through consideration of the family background and the impact of illness upon the family group.
  2. To demonstrate how the impact and interpretation of illness depends on personal attitudes by providing examples of harmonizing the Canadian medical model of care with the cultural and spiritual backgrounds of patients and families.
  3. To involve students in discussions on ethical aspects of caregiving including euthanasia, resuscitation, truth telling, paternalism, aggressive versus palliative interventional therapy, incompetent patients, fairness in the health care system, and strategies for resolving ethical issues.
Skill
  1. To enable students to integrate knowledge from across disciplines and to critically appraise clinical data, diagnostic tests, and the literature in order to assist with decisions to initiate or stop various investigations and therapy.
  2. To demonstrate various techniques for communication with patients and families as well as how and why these techniques would be modified based on the personal, educational, and cultural background of the patient and family.
Knowledge
  1. To describe the pathophysiology of common distressing symptoms in patients with advanced chronic disease and to suggest appropriate pharmacologic and non-pharmacologic techniques to combat these symptoms.
  2. To have students identify various organizational arrangements for delivery of Palliative Care and the relationship of these organizational structures to the existing health care system including the community resources available to patients with advanced illness and their families.
  3. To describe the elements of grief reactions and some techniques to prevent the development of pathologic reactions through caring for the patient and bereaved family.

HARVARD UNIVERSITY MEDICAL SCHOOL

Course Description: Living with Life-Threatening Illness—Care Near the End of Life

J. Andrew Billings, M.D., and Susan Block, M.D.

Caring for patients at the end of life is a basic task of doctoring and one for which students receive relatively little preparation and instruction. This



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