Cleveland Clinic Journal of MedicineProviding Comfort: Caring for Patients Who Wish to Die in their Home Country

Managing End-of-Life Transitions for Immigrant Patients

As global migration increases, healthcare providers encounter complex scenarios involving terminally ill patients desiring to return to their countries of origin to die. This article outlines practical strategies and considerations for medical teams to support these patients effectively, ensuring comfort and dignity during their final days.

Key Points:

• Early Discussions: Initiate conversations about end-of-life wishes early, especially for patients with diseases like cancer, where physical decline may happen rapidly, impacting their ability to travel.
• Travel Feasibility: Assess the patient’s physical and cognitive ability to travel. Minimal requirements include being cognitively interactive, capable of taking oral medications, and mobile with assistance.
• Travel Planning: Include considerations for travel mode, timeline, required assistance, and contingencies to manage potential issues during the trip.
• Medication Management: Prepare medication packs similar to US hospice practices, adapted for the patient’s journey and specific needs, ensuring they are simple to use and can address multiple symptoms.
• Safety and Training: Provide training for families in medication administration and patient care, emphasizing safety and independence in managing the patient’s needs after departure from clinical oversight.
• Legal and Documentation Advice: Ensure patients and caregivers carry necessary medical documentation and understand the legal implications of carrying medications across borders.
• Cultural and Ethical Considerations: Address cultural sensitivities and ethical implications of end-of-life care in a global context, ensuring decisions are patient-centered and respectful of their cultural values.
• In-Flight Emergencies: Discuss potential in-flight medical emergencies, including the rare possibility of death, preparing all parties for possible outcomes and responses.

“Providing counsel to terminally ill patients wishing to return to their country of origin is an academically challenging endeavor that many medical teams face. It is also one of the most professionally gratifying scenarios we encounter as we meet the patient’s goal of returning home.”

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