Basic properties of human consciousness in psychology and philosophy

Is human consciousness in psychology? Consciousness and the brain in brief! Properties of personality consciousness! Self-awareness, local focus, thought process, reflection, alter consciousness.

Hello, smart, energetic, curious readers !

Properties of consciousness

Consciousness is a reflection of objective reality in a person’s head. Each of us thinks in images that are born in the mind.

The higher the level of consciousness, the more a person is able to analyze his own actions and actions.

Consciousness allows a person to resort to deep reflection, think analytically and synthetically. A person with developed consciousness is always a person with high intelligence. The ability to analyze a situation and make responsible decisions characterizes a strong personality who knows how to admit even his own defeats.

The properties of consciousness are its significant characteristics that manifest themselves in the process of reflecting objects of the material world. Let's consider how these properties are expressed.

Coma

One of the most severe disorders of consciousness, characterized by its complete loss. There is also no reaction to any irritants, control of almost all vital functions is lost. The depth of coma is assessed on a 5-point scale. The following criteria are taken into account:

• independent opening of eyes;
• physical activity;
• speech;
• reaction of the pupils to light stimuli;
• convulsions;
• breath.

Basic properties of personality consciousness

Activity

One of the main properties of consciousness can be considered activity. Every action that a person performs has a motive and purpose. No one acts thoughtlessly, obeying only a chaotic combination of circumstances. If the goal is desired, then the person is often ready to make even incredible efforts to achieve it. Consciousness controls human behavior and tries to calculate everything in such a way that it is most beneficial to the person himself. Our ability to predict a situation and see our own prospects is a merit of consciousness. Such a property as activity allows consciousness to remain in a working state constantly. Under what circumstances is a person ready to take active steps? In the case when he understands the need for the actions taken.

Dynamism

By dynamism we understand such an orientation towards an object or phenomenon of the surrounding reality, in which consciousness reveals the ability for continuous development. The property of dynamism is that a person’s attention is always changing. We are able to concentrate for the most part only on what is truly meaningful and interesting to us. Turning to some object evokes various emotions; we connect our feelings to what we hear and see around us, what we observe. This property of consciousness as dynamism is always aimed at immersing in the essence of the phenomenon or object in question.

Constant reflection

It must be said that the ability to analyze one’s own actions and actions is an integral and significant characteristic of consciousness. A property called “reflection” helps at the right moment to turn to the source of your “I”, your inner essence and talk with it as frankly as possible. In such internal dialogues, a person often discovers that he lived and acted incorrectly, and was inattentive to his loved ones. Constant reflection is a property of consciousness that allows for effective self-observation at different periods of life. A person almost always compares his present self with the way he was before. Such a property of consciousness as reflection makes it easy to do this. Consciousness itself is capable of expanding and expanding a person’s understanding of the world.

Values ​​and motives

Another property of consciousness is its focus on internal sources of significance. We are talking about values ​​for the sake of which specific actions are taken. Human consciousness is of a motivational and value-based nature. A person sometimes has to make incredible efforts on himself in order to be able to negotiate with his inner conscience. Values ​​and motives set in motion his mental activity.

Thus, the properties of consciousness always reflect the essence of a particular personality, its internal nature and capabilities. Each person is completely individual and each has their own preferences.

Block 1. Consciousness. Introduction.

Well, what does consciousness have to do with it, you say, if you, guy, write books on negotiations, conduct trainings on negotiations, then why delve into such jungle, because this is a completely different topic, and also very complex, but on this “information walk” you can generally get lost, get lost and find yourself in front of the mysterious. And yet, my dear fellow traveler, with whom we are now in the same carriage, carrying us across the fields of life, I will touch a little on the most mysterious and incredibly interesting topic: THE CONSCIOUSNESS OF THE NEGOTITOR.

Let's put a bold exclamation mark right away! There is simply no single fundamental theory that explains consciousness at the current moment in time, and therefore my timid attempt to talk a little about the quality of the NEGOTITOR’S CONSCIOUSNESS is just an ardent desire to share with you, attentive and interested readers.

Article “Consciousness and the Quantum World”

Consciousness, its properties, characteristics

The psyche as a reflection of reality in the human brain is characterized by different levels.

The highest level of the psyche characteristic of a person forms consciousness.

Consciousness is the highest, integrating form of the psyche, the result of the socio-historical conditions for the formation of a person in work, with constant communication (using language) with other people.

Its first characteristic. Human consciousness includes a body of knowledge about the world around us. The structure of consciousness thus includes the most important cognitive processes: sensations and perceptions, memory, imagination and thinking.

With the help of sensations and perceptions, with the direct reflection of stimuli affecting the brain, a sensory picture of the world as it appears to a person at the moment is formed in the mind. Memory allows you to renew images of the past in the mind, imagination allows you to build figurative models of what is an object of needs, but is absent at the present time. Thinking ensures problem solving through the use of generalized knowledge.

The second characteristic of consciousness is the clear distinction enshrined in it between subject and object, i.e., that which belongs to a person’s “I” and his “not-I.” Man, who for the first time in the history of the organic world stood out from it and contrasted himself with his surroundings, continues to retain this opposition and difference in his consciousness. A person makes a conscious self-assessment of his actions and himself as a whole.

The third characteristic of consciousness is ensuring goal-setting human activity.

The functions of consciousness include the formation of goals for an activity, while its motives are formed and weighed, volitional decisions are made, the progress of actions is taken into account and the necessary adjustments are made to it, etc.

The fourth characteristic of consciousness is the inclusion of a certain attitude in its composition. The world of feelings inevitably enters a person’s consciousness, where complex objective and, above all, social relations in which a person is included are reflected. Emotional assessments of interpersonal relationships are represented in the human mind.

Basic functions of human consciousness

Reflective. Consciousness organizes cognitive processes (perception, representation, thinking), and also organizes memory.

Estimated. Consciousness takes part in the formation of some emotions and most feelings.

A person evaluates most events and himself at the level of consciousness.

Creative. Creativity is impossible without consciousness. Many voluntary types of imagination are organized at a conscious level: invention, artistic creativity.

Reflective. A type of consciousness is self-awareness - the process by which a person analyzes his thoughts and actions, observes himself, evaluates himself, etc.

Transformative. A person consciously defines most of his goals and outlines the path to achieving them.

Time-forming. Consciousness is responsible for the formation of a holistic temporal picture of the world, in which there is a memory of the past, awareness of the present and an idea of ​​the future. This is how human consciousness differs from the psyche of animals.

Properties of consciousness:

Activity - Consciousness is associated with activity, with an active influence on the world around us.

Selective nature - Consciousness is not directed at the whole world as a whole, but only at certain of its objects (most often associated with some unrealized needs)

Generalization and abstraction - Consciousness does not operate with real objects and phenomena of the surrounding world, but with generalized and abstract concepts, devoid of some of the attributes of specific objects of reality.

Integrity - The consciousness of a mentally healthy person, as a rule, has integrity.

Basic properties of consciousness

Within this property, internal conflicts of values ​​or interests are possible.

Constancy - Relative stability, immutability and continuity of consciousness, determined by memory.

The constancy of consciousness is determined by the properties of the individual.

Dynamism - Its changeability and ability for continuous development, determined by short-term and rapidly changing mental processes that can be fixed in the state and in new personality traits.

Distortion - Consciousness always reflects reality in a distorted form (some of the information is lost, and the other part is distorted by individual characteristics of perception and personal attitudes)

Individual character - The consciousness of each person is different from the consciousness of other people.

This is due to a number of factors: genetic differences, upbringing conditions, life experience, social environment, etc.

Ability to reflect - Consciousness has the ability to introspect and self-evaluate, and can also imagine how other people evaluate it.

Diagnostic methods

Given the variety of forms of the disease, each case requires an individual approach, and, unfortunately, doctors at the Leto mental health center sometimes cannot help. Thus, patients in a state of stupor, stupor and coma require emergency hospitalization. In such cases, all diagnostic and therapeutic measures are carried out in intensive care units.

Doctors at the Leto clinic diagnose qualitative disorders of consciousness. To determine the cause of the disease, an encephalogram is performed, a computed tomography scan of the brain is required, and, if necessary, a PET scan. We also ask for basic laboratory tests. Sometimes the patient is referred to related specialists.

Properties of consciousness

The term “consciousness” (co-knowledge) is currently a generalization that suggests itself based on the development of philosophy, anthropology, psychology and other areas of knowledge in the humanities and natural sciences, can be understood as the highest level of mental reflection and joint action.

Some naive anthropocentrists believe that such a level of development is possible only among representatives of human society. Meanwhile, scientists more familiar with the natural sciences would not say so.

In its most general form, from a systemic-pragmatic point of view, consciousness is a set of permanently changing sensations, sensory and mental images that appear before the inner gaze of a conscious subject and predetermine his practical and mental activity.

The properties of consciousness are studied in some branches of psychology, as well as in other areas of knowledge.

Properties of consciousness in psychology

There are several basic psychological properties of human consciousness:

1. The consciousness of a person (as an aware subject) is necessarily distinguished by activity, most of all conditioned by the specific specifics of the internal state of the subject at the time of action. In most cases, we can talk about the subject having a specific goal and consistent vectors of activity to achieve the goal.

• The consciousness of the subject is characterized by intentionality, that is, a focus on something (not necessarily an object of the material world, not necessarily a specific one). Consciousness is always awareness (or awareness, and at the moment of communication with another subject or group, even co-awareness) of some fact or thought.
• Consciousness is characterized by constant reflection, that is, the subject undergoes a process of continuous introspection. The subject may be aware of the very presence of consciousness and recognition.
• Consciousness is mainly of a motivational and value-based nature (at least among Europeans). Of course, at the present moment in the development of knowledge about man, it would be naive, rude and flat; it would be in vain to think that consciousness is always motivated. This is a mossy thought from the middle of the last century. However, it can definitely be argued that a real subject in our world always strives for a goal (even if the goal is the absence of a goal), he is forced to this by attachment to a completely material living organism.

Other important properties of consciousness include: integrity, abstraction, generality, selectivity, dynamism, distortion, uniqueness and individuality.

In general, it should be understood that although consciousness arises in our world only in real living thinking subjects, it is classified as the sphere of the ideal, since images, sensations and meanings cannot be considered as material objects.

What philosophers say

Philosophers believed that consciousness does not exist in isolation from reality. It is the relationship of oneself with reality.

We see the world around us and feel, perceive, think, and fantasize something in connection with it.

Different directions of philosophy interpreted this concept in their own way:

1. dualism tends to divide man into consciousness and matter, where the first is spirit, the second is body. Consciousness is eternal, since it continues to live even after the physical death of the body;
2. According to idealism, consciousness comes first, then the surrounding world. Matter does not exist if it is unconscious;
3. materialists wrote that only highly organized matter, which is capable of creation, has consciousness (I understand that we are talking about a person).

CONSCIOUSNESS AND PSYCHE. SIGNS AND PROPERTIES OF CONSCIOUSNESS.

The understanding of consciousness, which arose in ancient times and existed for centuries, identifies it with all the psychological characteristics of a person.

Everything that is connected with the human soul, everything in which it manifests itself, was attributed by ancient scientists to the content of consciousness, since the psyche is, in essence, consciousness and there is no other psyche (unconscious).

Thanks to the works of Rene Descartes and John Locke, based on this statement, psychology has long turned into a science of consciousness (although the unconscious in the psyche is also recognized, but still this topic is little touched upon).

There is a point of view that connects a person’s consciousness with experiences, images, thoughts that he is able to describe in some way and about which he is somehow able to communicate to other people.

Consciousness in this definition is a joint, universal knowledge of people, knowledge shared by people, which is able to be transmitted from person to person and as a result become general or collective knowledge. Many scientists relate consciousness exclusively to language and speech, i.e., only what is transmitted through words enters consciousness and can exist in it.

Principles of therapy

Drug treatment is indicated. With a deep disorder of consciousness, contact with reality is lost, and not a single psychotherapist is able to “reach out” to the individual. Relief of acute symptoms is carried out in the hospital of the Leto clinic under round-the-clock medical supervision. If necessary, we will arrange transportation to the medical center.

The list of drugs used, their dosage, and duration of treatment depend on individual characteristics and the diagnosis. As a rule, sedatives and drugs for symptomatic therapy are used. After the patient’s condition improves, the patient is discharged, but the doctor must describe in detail the further treatment plan and talk about the need for consultations to correct the treatment plan.

The concept of consciousness. Functions and properties of consciousness.

In other words, consciousness includes only general knowledge, presented at the level of concepts about objects and phenomena that are reflected in language.

There is an interpretation of consciousness as a special state of a person’s psyche in which he is when he correctly perceives what is happening to him and around him at a particular moment and is not sleeping. This point of view assumes the appearance and disappearance of consciousness in a person, as well as his transition to an unconscious state, i.e., the possibility of a person and the psyche being outside consciousness.

The presence of consciousness in a person can be judged by whether or not at the moment there are signs indicating that the person is in this state.

There are several such signs: the ability to describe it in words and imagine it using certain images; the ability to communicate one’s own feelings and thoughts to other people, the ability to separate oneself from what is happening around and determine what is happening inside.

Due to the fact that this is a state of the human psyche, we perceive it as dynamic, since it can change from time to time.

It follows that a change in the state of consciousness itself is possible. It can be strengthened and weakened, it has its own measure, that is, it can be strong and weak.

The psyche as a reflection of reality in the human brain is characterized by different levels.

The highest level of the psyche characteristic of a person forms consciousness. Consciousness is the highest, integrating form of the psyche, the result of the socio-historical conditions for the formation of a person in work, with constant communication (using language) with other people.

In this sense, consciousness, as the classics of Marxism emphasized, is a “social product”; consciousness is nothing more than conscious being.

What is the structure

consciousness, its most important psychological characteristics?

Its first characteristic is given in its very name: consciousness

.

Human consciousness includes the totality

knowledge about the world around us.
K. Marx wrote: “The way in which consciousness exists and in which something exists for it is knowledge
.” The structure of consciousness thus includes the most important cognitive processes with the help of which a person constantly enriches his knowledge.

These processes may include sensations

and
perception, memory, imagination
and
thinking
.
With the help of sensations
and
perceptions
, with the direct reflection of stimuli affecting the brain, a sensory picture of the world as it appears to a person at the moment is formed in the mind.

Memory

allows you to resume images of the past in your consciousness,
imagination
- to build figurative models of what is an object of needs, but is absent at the present time.
Thinking
ensures problem solving through the use of generalized knowledge.

A disturbance, a disorder, not to mention the complete collapse of any of these mental cognitive processes, inevitably becomes a disorder of consciousness.

distinction between subject and object enshrined in it

i.e., what belongs to a person’s “I” and his “not-I.” Man, who for the first time in the history of the organic world stood out from it and contrasted himself with his surroundings, continues to retain this opposition and difference in his consciousness.

He is the only living being capable of self-knowledge

, i.e., turn mental activity to explore oneself. A person makes a conscious self-assessment of his actions and himself as a whole.

The separation of “I” from “not-I” is the path that every person goes through in childhood, carried out in the process of forming self-awareness

person.

The third characteristic of consciousness is ensuring goal-setting human activity

. The functions of consciousness include the formation of goals for an activity, while its motives are formed and weighed, volitional decisions are made, the progress of actions is taken into account and the necessary adjustments are made to it, etc.

Palliative care in the last days of a person’s life

“Those whom we ourselves accompany in the last phase of life,

teach us that

that preparation for death is the best preparation for life itself.”

The death of a palliative patient is a natural outcome of a chronic disease. The doctor’s task is not to artificially prolong the dying process, but to preserve the quality of a person’s life until the very end. Doctors must relieve painful symptoms, provide the patient with high-quality, sensitive care, and also help his loved ones cope with the loss of a loved one.

The article was prepared based on materials from a webinar by Diana Sitnikova, head of the department at the Moscow Multidisciplinary Center for Palliative Care of the Department of Health.

Why don't we provide resuscitation to palliative patients?

Resuscitation measures for a palliative patient lead to an artificial prolongation of the dying process. There is also a legislative basis for this.

Federal Law No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens of the Russian Federation” states:

Resuscitation measures are not carried out: in a state of clinical death (stopping the vital functions of the human body (blood circulation and breathing) of a potentially irreversible nature in the absence of signs of brain death) and against the background of the progression of reliably established incurable diseases or incurable consequences of acute injury that are incompatible with life.
Resuscitation. Can she help? What you need to know about resuscitation and the condition of a person in the terminal stage of illness in order to make the right decision at the end of the life of a loved one Vera Foundation
Receiving palliative care

What are the terminal states?

• Predagonia;
• Terminal pause;
• Agony;
• Clinical death;
• Biological death (more about each of them below).

What the doctor needs to do:

• Adjust patient care - make it more gentle, abandon unnecessary manipulations;
• Remove unnecessary drainages, catheters, nasogastric tubes, etc.;
• Adjust therapy, discontinue medications that will not affect the quality and length of life;

Important It is necessary to continue pain relief with possible dose titration to achieve an adequate analgesic effect until the very end!

• Discuss his condition with the patient’s loved ones and explain what to expect.

Communication with the patient's loved ones

• Tell the patient's relatives what will happen to their loved one. Point out to them that what they perceive as torment is not always so for the patient.
• Give people time to accept the inevitability of loss as much as possible.
• Remind them that it is important to have time to resolve everyday, legal and civil issues: write a will, deeds of gift, etc.
• Help people spend time with a loved one: say something unsaid, finish something.
  Spiritual testament: how to convey your experience to loved onesAbout the practice of writing letters in which a person can summarize his life, give parting words and share lessons with those who will remain after his passing The GroundSwell Project

  End of life

What can be done for the patient?

If a person is in a hospital, if possible, transfer him to a separate room and provide comfortable conditions. If the person is religious, offer to invite a clergy member and arrange for the visit if the patient agrees.

Organize an individual nursing station.

A person should not leave alone, even if he is already unconscious. One of the junior or nursing staff must be with the patient at all times.

Don't involve volunteers or interns in this - they may not be competent at this. The person nearby should have time to notice changes in the patient’s condition and inform the doctor about it in time.

Learn more about each phase of dying

Predagonia

Predagonia is characterized by severe circulatory and respiratory disorders, which lead to hypoxia. In the central nervous system at this moment, the process of inhibition predominates, the electrical activity of the cerebral cortex fades away.

Predagonia can last from 1 day to 1 month. The duration depends on the rate of progression of the underlying disease, the age of the patient and the initial resources of the body.

Symptoms of preagonia:

• Tendency to hypotension, hemodynamic disturbances;
• First tachycardia, tachypnea - then bradycardia and bradypnea;
• Progressive depression of the level of consciousness. From lucidity to coma;
• Increased hypoxia;
• If the patient is conscious, there is a gradual decrease in appetite;
• Oliguria, changes in the skin;
• Cyanosis, marbling of the skin;
• Hyperthermia.
  Practical recommendations for the treatment of painful symptoms To help medical specialists, we have prepared practical recommendations for the treatment of the most common painful symptoms and conditions in palliative practice: nausea and vomiting, shortness of breath, constipation, itching, hiccups, anorexia and cachexia.

What should you do during this period?

First, hydration therapy (infusions or enteral nutrition) should be gradually reduced. If the life expectancy is several hours, stop completely. This should be done if the patient is already unconscious.

Important All actions must be coordinated with the patient’s relatives.

Continue symptomatic therapy - if there are any painful symptoms, including pain, continue to relieve them.

If the patient is at home, the question of hospitalization is raised in the following cases:

• If a person has pain or convulsive syndrome that cannot be controlled at home;
• Delirium requiring medical sedation;
• Obvious defects in care;
• If relatives are physically unable to care for a person in serious condition;
• If hospitalization is requested by the patient himself or his relatives who are not ready for the person to leave at home.

In this phase, we try to choose the least invasive method of administering drugs to the patient. Most often this is the buccal method. If the patient is still swallowing, tablet forms can be continued. The drugs can also be administered transdermally. You should switch to subcutaneous or intravenous injections only if necessary - with complete depression of consciousness and absence of swallowing. We try to avoid the intramuscular method, as it is the most painful.

Terminal pause

This phase is often difficult to identify. The terminal pause is characterized by:

• Sudden stoppage of breathing;
• Consciousness is completely absent;
• Peripheral reflexes are significantly reduced or completely absent;
• Muscle tone is minimal;
• A complete cessation of cardiac activity is possible.

Most often, the terminal pause ends in clinical death, bypassing all subsequent phases.

Agony

During this period, maximum activation of the body's resources to support life occurs. Against the background of pronounced inhibition of the cerebral cortex, strong excitation of the bulbar centers occurs.

The duration of agony depends on the type and mechanism of death, as well as on the adaptive capabilities of the body. It can last from several minutes to several hours, and sometimes be absent altogether.

Dr. Elisabeth Kübler-Ross. From the book “In the Middle of Life” The author of the concept of the five stages of grief, she saw the horrors of war, became a doctor at 31 and devoted her life to caring for the terminally ill Editors

About palliative care

Signs of agony:

• There is no consciousness;
• Terminal (agonal) breathing;
• Decreased pupillary response to light, no pharyngeal or corneal reflex;
• Muscle tone is reduced, but there may be decerebrate muscle rigidity;
• Convulsions;
• Hyperthermia or hypothermia;
• Hemodynamic disturbances;
• The pulse can only be felt in the carotid arteries;
• Discharge of biological vomiting and discharge of feces and urine;
• Tendon reflexes are absent;
• Maximum activation of the body’s vital forces is possible (this happens rarely);
• Lazarus syndrome, when flexion movements appear in the trunk and limbs, and the patient seems to sit down, raising his hands to his face - the so-called “boxer pose” (this happens extremely rarely).

At the end of the agony, manifestations of neuro-reflex activity completely disappear.

What should you do during this period?

Continue taking opioid analgesics. However, if the patient is unconscious, if there are no signs of pain and, in all likelihood, the end of life is a matter of minutes, then all interventions should be stopped. The same applies to positioning a person in bed - there is no need to turn him. The risk of developing bedsores is no longer important.

Important There should be a minimum of interventions at this stage! We leave only moisturizing of the mucous membranes, oral cavity, lips, conjunctiva.

Clinical death

The main signs of clinical death:

• Lack of consciousness;
• Lack of spontaneous breathing;
• Absence of pulse in the main arteries;
• Wide pupils;
• Lack of pupillary response to light and corneal reflex;
• Paleness, cyanosis of the skin.

Biological death

It is characterized by irreversible changes in all organs and systems that are permanent, cadaveric in nature.

A morgue is a civilized place. An interview with forensic expert Olga Fateeva about how a morgue works, what happens to a person’s body after death, why the deceased may be completely different from his living self, and whether embalming is always necessary Evgeniya Rezvan

End of life

Features:

• Early - drying and clouding of the cornea, a symptom of "cat's eye".
• Late - cadaveric spots and rigor mortis.

Practical advice

After declaring death, the doctor’s diary must indicate:

• – pallor and cyanosis of the skin;
• – lack of consciousness;
• – lack of breathing;
• – absence of pulse;
• – lack of reaction of the pupils to light;
• – absence of corneal reflex.

The exact date and time of death is also indicated.

What to do with painful symptoms in terminal conditions

Asthenization

Make sure the person is in a comfortable position in bed. Turn and move it less. You can massage before and after turns, especially in problem areas (such as bony prominences).

Important:

do not force the patient to do more than he wants or is able to do. Turns every two hours are no longer relevant. Absorbent underwear should be changed only when necessary: ​​if the patient does not urinate, then there is no need to do this.

Depressed level of consciousness

The depression of consciousness can be gradual or, conversely, abrupt. May begin with increased sleepiness and difficulty waking up. The patient may have no initial reactions to verbal and tactile stimuli. Speech function deteriorates: the patient finds it increasingly difficult to find words, he gives monosyllabic, slow, sometimes inadequate answers, which he thinks about for a long time. Speech may also be completely absent.

What to do?

• Even if it seems that the patient does not hear or understand the spoken speech, you still need to warn about all your actions, speak calmly and quietly, and do not rush into answers.
• If the person does not seem to recognize anyone, we still talk to him as if he were a capable person.
• Continue pain therapy if we are 100% sure that it is not the cause of depression of consciousness.
• If the patient is unconscious, do not discuss the diagnosis or prognosis in front of him. Also don't do it if he doesn't want to talk about it.
• Do not talk about the patient in the third person.
• Avoid excessive activation, do not disturb the person, giving time to rest.
  Palliative sedation: regulatory, ethical and clinical aspectsWhen is palliative sedation needed, is it necessary to obtain the patient’s consent and what moral problems will one have to face Diana Nevzorova Tatyana Gremyakova

  Pain management at the end of life

What do relatives often ask?

Question: Why does he sleep all the time?

Variant answer: The patient does not have the strength to talk or stay awake due to increasing intoxication. If you imagine very severe poisoning, multiplied by a hundred times, this is what your relative is experiencing now. All the forces of his body are aimed at maintaining the central functions of the body: breathing, heart function. Sleep is a defensive reaction.

Question: Is it from the drugs you give him?

Possible answer: If this were a side effect of narcotic analgesics, it would appear during the initial intake or after increasing the dose. If this does not happen, then most likely the patient’s condition is associated with the manifestation of the underlying disease.

Hemodynamic disorders

Tachycardia, hypertension followed by hypotension, peripheral cooling, cyanosis, marbling of the skin.

What to do?

• If the patient feels weak due to a decrease in blood pressure, administer glucocorticosteroids (if there are no contraindications).
• Warm with a heating pad, always wrapped in a cloth or towel.
• Give a light massage if you feel chilly.

Under no circumstances should you carry out massive infusion therapy or administer vasopressors, as this is an artificial prolongation of life!

What do relatives often ask?

Question: Why are my hands and feet cold and cyanotic?

Variant answer: There is a redistribution of blood flow and centralization of blood circulation: the main blood flow is directed to the heart and brain, and less blood flows to the periphery (to the legs and arms).

Question: Why don’t you increase your blood pressure with medications?

Variant answer: At the moment, a decrease in blood pressure does not lead to worsening of the condition and death, but is a sign that the person is leaving. If we increase the pressure, we will artificially prolong his agony and, most importantly, his suffering.

Terminal breathing

There are several types of terminal breathing. The most common are those associated with an imbalance between excitation and inhibition in the central nervous system. The most common: Cheyne-Stokes, Biot, Grock or Kussmaul breathing.

What can you do about it?

• Give the person a comfortable position. Typically this means raising the head end of the bed.
• Continue to care for your oral cavity - moisturize the mucous membranes. With pathological breathing, the mouth is open, which means the mucous membranes dry out.
• Continue with previously prescribed opioid analgesics. Perhaps with dose titration.
• If you have previously started low-flow oxygen therapy, you can continue it. Under no circumstances stop it in the presence of relatives! Only if we could convince them that this was no longer necessary.

Death rattle

This painful symptom often worries the patient’s loved ones. It no longer bothers the person himself. It can be combated by administering moderate doses of M-anticholinergic drugs, for example, atropine. Or simply by turning the patient's head to the side. Mechanical ventilation should not be prescribed unless it has already been started (except in patients with ALS).

Palliative care for patients with ALS Breathing and swallowing disorders, communication difficulties and other symptoms in amyotrophic lateral sclerosis Vadim Parshikov

Symptomatic treatment

What do relatives often ask?

Question: Why did breathing change?

Variant answer: Our breathing is regulated by the respiratory center, which is now in a state of hypoxia. This can cause breathing to become irregular. This is a natural process.

Question: Why does the patient wheeze? Perhaps he is suffocating?

Variant answer: The sound is associated with impaired evacuation of bronchopulmonary secretions. The person cannot cough it up, and it seems that he is choking. This is not so: in fact, the person does not feel it, and he does not have the need to clear his throat.

Question: Do something, he’s suffering!

Variant answer: We understand how difficult it is to look at a loved one in such a state, but, believe me, the person himself no longer experiences suffering.

Lack of appetite and gradual decrease in fluid intake

What can be done?

• Give the patient small, frequent sips of water.
• If this is not possible, or the patient refuses by clenching his teeth (sometimes this is the only way for a person to show that he does not want to do this), try to irrigate the oral cavity with water or special gels such as artificial saliva.
• If, on the contrary, a person wants to eat, clarify his taste preferences. Someone wants champagne, someone wants red caviar - on their deathbed, everything is possible.
• When fluid intake is reduced, subcutaneous administration of saline is an option. We are always afraid of dehydration, since this can cause a deterioration of the condition - depression of consciousness, the development of delirium, constipation, etc.

Important: Do not force feed the patient under any circumstances!

Parenteral and enteral nutrition is contraindicated for patients in terminal conditions. This will not help anything and will not prolong life.

A nasogastric tube is placed if the prognosis for survival is several weeks. Installation of a gastrostomy tube is indicated if the life expectancy is at least 6 months.

Nasogastric tube: placement, feeding rules, prevention of complications Technique for placing the tube, possible complications and their prevention Varvara Brusnitsyna

Symptomatic treatment

What do relatives often ask?

Question: A person is dying of hunger, why does he refuse food?

Possible answer: Loss of appetite at this stage is normal and natural. All body functions are slowed down, so less energy is needed. The man is not hungry. If he wanted, he would eat. We cannot force him.

Question: Why is enteral nutrition not prescribed?

Variant answer: The body no longer has the energy resources to digest and assimilate food, the gastrointestinal tract is not able to extract nutrients. Blood circulation is aimed only at maintaining the functioning of the heart and brain. Enteral nutrition in this phase will not give anything.

Pain management at the end of life

• Continue pain management based on the severity of the person's condition. Opioids should not be discontinued if confusion or unconsciousness occurs. Rate pain using the PAINAD scale.
• If the patient can no longer speak, assess his pain behavior.
• If there is no swallowing, the patient should be switched to injectable forms of analgesics in an equivalent dosage.

Important In a number of patients in the terminal phase, pain becomes refractory and cannot be effectively treated. In this case, opioids are used in invasive forms in the form of prolonged subcutaneous or intravenous infusion. Their use is possible only in a hospital setting.

In some cases, with refractory pain, additional drug sedation is possible.

Delirium, agitation, increased anxiety

First, find out the cause of the agitation. It may be associated with unmet physical needs - unrelieved pain, bladder or bowel fullness.

If it is not possible to find out, the patient should be preventively anesthetized. That is, exclude pain as a possible cause.

It is necessary to show the patient that the doctor is his ally. Speak calmly and confidently. Do not object or argue with the patient. If this does not help, you should resort to drug treatment: haloperidol intramuscularly, if this does not help, aminazine.

Confusion, disorientation, anxiety - how to help? Sometimes terminally ill patients become agitated, cannot calm down, can get confused in time and space, and see people and things that are not there. What can be done for them? Vera Foundation

End of life

What do relatives often ask?

Question: Can a person in such a state harm himself?

Variant answer: In this condition the patient is already too weak. Most likely, he simply does not have enough strength for this. In addition, we will not allow him to be left alone, and we will install an individual nursing station in the ward.

Question: Why is this happening, why does he behave this way?

Variant answer: This condition is not a manifestation of a mental illness, but a consequence of dysfunction of internal organs, endogenous intoxication.

Question: Can he be calmed down?

Possible answer: Yes, but the patient may become drowsy and difficult to contact.

Ethical and psychological aspects of accompanying the patient and his family in the last hours of life

What should the doctor do before the patient reaches a terminal condition?

• Understand which of your loved ones will be with the patient and will participate in decision-making.
• Assess the extent to which the patient himself is aware of the approach of death: his speech and communication characteristics should be taken into account.
• Find out what the patient wants to know about his diagnosis and life prognosis. Ideally, find out where the person wants to die. There are people who fundamentally want to die at home. It is better to know about this in advance in order to provide transportation, painkillers, and organize visits from the patronage service - that is, arrange hospice at home.

By the way, the British palliative care doctor Bruce Cleminson said that information about the diagnosis belongs, first of all, to the patient. Read it!

In the last hours of a person’s life, his loved ones also need help. Talk to them, explain in advance what they can expect, discuss their fears and concerns.

After a person's death, their loved ones still need help. After all, this is only the beginning of their grief journey. In the Palliative Care Center of the Moscow Health Department, we can offer a consultation with a psychologist and provide the necessary literature. Usually people are confused, they need to clearly explain further actions, because they still have a lot of work to do.

After pronouncing death

• Notify a relative of the death if they were not present.
• Offer a farewell in a comfortable, private setting - only if the relative wants it (some people don’t want this on principle, because it’s morally difficult for them). Explain that there will be an opportunity to say goodbye at the morgue.
• Get ready to have to explain everything to your relatives several times.
• Provide relatives with information brochures to help them understand their next steps.
• Try to complete the documentation quickly. This determines how soon the body will be sent to the morgue and the funeral will take place. This can be very important for the patient's loved ones.

The material was prepared using a grant from the President of the Russian Federation provided by the Presidential Grants Foundation.

Stock image used from Depositphotos.