Palliative Versorgung bei Früh- und Reifgeborenen mit sehr ungünstiger Prognose

Abstract

Involvement of the family in decisions to withhold or withdraw intensive care and parental involvement in care planning for terminally ill infants does not aggravate or prolong parents' grief responses, their feelings of guilt, or the incidence of pathological grief responses. Effective physical pain and symptom management is critically important. Compassionate care plans, however, need to implement a number of other and equally important components. Parents are not uniform in their perceived needs to make various kinds of contacts with their dying infant. They should be allowed to make their individual choices regarding contact with their baby during that time. The perinatal loss of a twin infant appears to evoke no less serious stress and risks to parents' compared to the loss of a singleton. The disruption of family life during a perinatal loss affects siblings of the baby, and their specific needs should be acknowledged. Post-death or post-autopsy meetings with the family should routinely be scheduled a few weeks after death, and bereavement support should actively be offered. Parents need to be informed about differences to be expected between maternal and paternal grief responses. The risk of pathological grief variants and chronic grief should be mentioned to parents because professional help is required in such occurrence.

Neuropsychological Comparison of Guilt and Grief: A Review of Guilt Aspects in Prolonged Grief Disorder

“…Other significant empirical studies exist that particularly link guilt to development of PGD remain scarce. Of those articles that do mention a relationship of guilt to pathological forms of grief, they tend to list guilt as among a constellation of emotions, for example as experienced by those grieving suicide (Norris & Clark, 2012), in combat-related comorbid PTSD as survivors' guilt (Simon et al, 2018;, in surviving family and caregivers of those chronically ill (Lientscher, 2006), after abortion (Gurpegui & Jurado, 2009;Whitney, 2017), and following stillbirth and perinatal death (Hvidtjørn et al, 2018;Mart ınez-Serrano et al, 2019;Schulze & Wermuth, 2007;Wells, 1991). Guilt thus commonly figures into popular and scholarly accounts of prolonged grief (and its predecessors prior to PGD codification) and warrants theoretical and empirical inquiry into guilt's mechanisms in grief and treatment of prolonged grief.…”