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End-of-life Decisions (end-of-life + decision)
Terms modified by End-of-life Decisions Selected AbstractsEND-OF-LIFE DECISIONS AND OLD-AGE MORTALITY: A CROSS-COUNTRY ANALYSISJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Fanny Janssen PhD No abstract is available for this article. [source] Non-invasive ventilation in do-not-intubate patients: five-year follow-up on a two-year prospective, consecutive cohort studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009H.-H. BÜLOW Background: End-of-life decisions are common in intensive care units (ICUs), and increasingly, non-invasive ventilation (NIV) is used as a ceiling of ventilatory care. However, little is known about the outcome following that decision. Methods: An observational, single-center, retrospective, follow-up study with no interventions, on ICU patients treated with NIV and a do-not-intubate (DNI) order. The patients were followed until a 5-year survival rate could be calculated. Results: One hundred and fifty-seven patients were treated with NIV during 2002 and 2003, and among 38 a DNI order was in effect. Of the 38 DNI patients, 11 died in the ICU, 16 died on the ward and 11 survived the hospital stay. Five of these 11 survivors died within 6 months, two died after 2.7 and 3.3 years, respectively, but four were still alive after 5 years. The long-term (>6 months) survivors have, surprisingly only been admitted to the hospital 0,2 times a year , and seldom with the need for ICU treatment. Conclusions: According to this study, and previous ones, it seems worthwhile treating DNI patients with NIV. Twenty-five to 35% leave the hospital alive, every 6th patient lives for at least 1 year, and this paper shows that 10% may survive for 5 years or more. However, only chronic obstructive pulmonary disease and chronic heart failure patients (both with a concomitant low APACHE score) seem to have a reasonable outcome, and patients should be informed about this. So far, no study has investigated the quality of life of these survivors. [source] Do-Not-Resuscitate Policy on Acute Geriatric Wards in Flanders, BelgiumJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2005Cindy De Gendt MSc Objectives: To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. Design: Structured mail questionnaires. Setting: All 94 acute geriatric wards in hospitals in Flanders in 2002 (the year Belgium voted a law on euthanasia). Participants: Head geriatricians. Measurements: A questionnaire was mailed about the existence, development, and implementation of the DNR policy (guidelines and order forms), with a request to return copies of existing DNR guidelines and DNR order forms. Results: The response was 76.6%, with hospital characteristics not significantly different for responders and nonresponders. Development of DNR policy began in 1985, with a step-up in 1997 and 2001. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. Geriatric wards in private hospitals implemented their policy later (P=.01) and more often had order forms (P=.04) than those in public hospitals. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. Conclusion: Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions. [source] Randomized controlled trial of SPIRIT: An effective approach to preparing African-American dialysis patients and families for end of life,RESEARCH IN NURSING & HEALTH, Issue 3 2009Mi-Kyung Song Abstract This randomized controlled trial tested an intervention, Sharing Patients' Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N,=,58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients' deaths and surrogates' end-of-life decision making to assess surrogates' perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:260,273, 2009 [source] Life and Death Decisions in our Posthuman(ist) TimesANTIPODE, Issue 1 2009Louisa Cadman Abstract:, Geography, like much of social science, is witnessing a resurgence of interest in Michel Foucault's formation of biopower,the power to make live and foster life. This paper seeks to engage with this interest by staging a dialogue between the work of Nikolas Rose and Paul Rabinow on the one hand and that of Giorgio Agamben on the other. I propose that, while Rose and Rabinow provide a diagnostic for our emerging geographies of "life itself" and outline allied forms of political citizenship known as "biosociality" or "biological citizenship", it is Agamben who enables us to consider the limit figures to this form of political inclusion. To draw out these limit figures I focus on recent debates surrounding end-of-life decisions and provide examples from the Dignity in Dying campaign and the Not Dead Yet movement. Throughout, I situate this paper within recent debates on posthumanism and the posthuman in geography. In doing so I effectively ask: why, in our seemingly posthuman(ist) times, does much of Western politics seek to decide on the form, the right and, inevitably, the limit of human beings? [source] Legal implications for failure to comply with advance directives: an examination of the incompetent individual's right to refuse life-sustaining medical treatmentBEHAVIORAL SCIENCES & THE LAW, Issue 3 2002Sherynn J. Perry Life-sustaining medical technology in the past century has created a growing body of case law and legislation recognizing the incompetent individual's right to make his or her own end-of-life decisions. This article focuses on California's leadership in the area of these specific end-of-life issues: specifically, exploring the right of an incompetent individual to refuse life-sustaining medical treatment. The article examines advance directives along with various judicial decision-making standards for incompetent individuals and explores the sociobehavioral and legal rationale for compliance with incompetent individual's rights to make end-of-life decisions. Finally this article concludes (i) that advance directives allow competent individuals to state the medical treatment they would prefer in the event they should later become incompetent and (ii) that when advance directives are properly executed in a detailed manner, under laws currently in effect in some jurisdictions, the preferences stated in the directive bind health care providers. Copyright © 2002 John Wiley & Sons, Ltd. [source] MORAL FICTIONS AND MEDICAL ETHICSBIOETHICS, Issue 9 2010FRANKLIN G. MILLER ABSTRACT Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices is based on a series of moral fictions , motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. [source] Flaws in the assessment of the best interests of the newbornACTA PAEDIATRICA, Issue 4 2009Carlo V Bellieni Abstract We examined the literature on ethical decisions regarding neonates, to assess whether personal beliefs and prejudices influence end-of-life decisions taken by caregivers. Studies show that religion and familiarity with disability influence caregivers' decisions, whereas the influx of already being a parent, age, sex and professional experience is controverse. Caregivers' attitudes towards end-of-life decisions are also affected by personal concerns about litigation, prejudices and their view of disability. The concept of ,poor quality of life' is widely used as a reference in end-of-life decisions, but this can be interpreted differently, leaving room for a wide range of personal viewpoints. In most cases, parents' opinions are considered important and are sometimes the main determinant in decision making. However, it is unclear whether parents' decisions are based on their own wishes or on the best interests of the newborn. Conclusion: In neonatal end-of-life decisions, patients may not receive cures based only on their best interests. [source] | |||||||||||||