Bioethics for clinicians: 21. Islamic bioethics.
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Islamic bioethics derives from a combination of principles, duties and rights, and, to a certain extent, a call to virtue. In Islam, bioethical decision-making is carried out within a framework of values derived from revelation and tradition. It is intimately linked to the broad ethical teachings of the Qur'an and the tradition of the Prophet Muhammed, and thus to the interpretation of Islamic law. In this way, Islam has the flexibility to respond to new biomedical technologies. Islamic bioethics emphasizes prevention and teaches that the patient must be treated with respect and compassion and that the physical, mental and spiritual dimensions of the illness experience be taken into account. Because Islam shares many foundational values with Judaism and Christianity, the informed Canadian physician will find Islamic bioethics quite familiar. Canadian Muslims come from varied backgrounds and have varying degrees of religious observance. Physicians need to recognize this diversity and avoid a stereotypical approach to Muslim patients. (+info)
Primitive society, health & elderly.
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Mankind have been ravaged by diseases since primitive age and remedial measures were emprirical learnt either by accident, experience or superstition. But most elderly population were killed and hardly died of diseases. Fate of women were no better. Care for elderly came with civilization. They were little better in the East compared to the West. Although elderly population were better treated in India, China tops the list for elderly care. Even today the oldest man in the family is most respected. Civilized nations even today discriminate elderly population compared to children and adult, but apply the yardstick in a different manner, direct killing alone is not allowed. (+info)
Collusion in doctor-patient communication about imminent death: an ethnographic study.
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OBJECTIVE: To discover and explore the factors that result in the "false optimism about recovery" observed in patients with small cell lung cancer. DESIGN: A qualitative observational (ethnographic) study in 2 stages over 4 years. SETTING: Lung diseases ward and outpatient clinic in a university hospital in the Netherlands. PARTICIPANTS: 35 patients with small cell lung cancer. RESULTS: False optimism about recovery usually developed during the first course of chemotherapy and was most prevalent when the cancer could no longer be seen on x-ray films. This optimism tended to vanish when the tumor recurred, but it could develop again, though to a lesser extent, during further courses of chemotherapy. Patients gradually found out the facts about their poor prognosis, partly by their physical deterioration and partly through contact with fellow patients in a more advanced stage of the illness who were dying. False optimism about recovery was the result of an association between physicians' activism and patients' adherence to the treatment calendar and to the "recovery plot," which allowed them to avoid acknowledging explicitly what they should and could know. The physician did and did not want to pronounce a "death sentence," and the patient did and did not want to hear it. CONCLUSION: Solutions to the problem of collusion between physician and patient require an active, patient-oriented approach by the physician. Perhaps solutions have to be found outside the physician-patient relationship itself--for example, by involving "treatment brokers." (+info)
Behaviour of the dying patient.
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One hundred and ten dying patients were studied during the 24 hours before death and 250 patients during the weeks before death: 60% were well orientated in time and space 24 hours before death and 26% at 15 minutes before death. A control group of patients with serious, but not fatal, illness were also studied. There was a contrast in attitude to death between the dying patients and the ill but not dying controls. The dying were resigned to their approaching death, experienced little or no fear, and did not wish to know about their illness, whereas the control patients wanted information about their condition and feared death, though few thought they would actually die. The relief of physical symptoms in the dying is important. There was often a brief improvement in condition, with reduced need for analgesic, shortly before death. (+info)
Family members' experiences of autopsy.
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BACKGROUND: The experiences of family members will teach us how to handle an autopsy, the ultimate quality assessment tool. OBJECTIVE: The aim of this study was to determine surviving family members' experience of autopsy. METHOD: Seven GPs were asked to approach surviving family members of autopsied patients to ask for their co-operation with an interview about their experiences. The interview took place at the residences of the individual families, 6 months to a year after the autopsy. A partially structured set of interview questions was used by the interviewer (not a GP) who had experience with the grieving process and with grief counselling. RESULTS: Twelve family members of autopsied patients were interviewed: six partners, three mothers, one offspring and two sisters. In the case of one 35-year-old man, the autopsy was performed as a judicially required post-mortem. The GP initiated the autopsy request in eight cases. It appears that there is definite room for improvement in how the GP handles the topic of autopsy. The best way to explain it is to compare an autopsy with an operation. Several family members had specific concerns about the appearance of their relative after the autopsy. Several of the family members indicated that they were reassured by the autopsy results. Clarity about the cause of death was important, and reassurance that they had not overlooked important symptomatology helped the family members in their grieving process. CONCLUSION: A request for autopsy is one of the most difficult questions which has to be asked at a very difficult time. Three main considerations were important for the relatives: they wanted an answer to the questions "Is there something I overlooked", "How could this have happened" and "Are there hereditary factors which could have consequences for the rest of the family?" The GP is the optimal professional to discuss the autopsy report with the surviving family members. The best approach for the GP includes an open attitude, paying attention to informing the family and supporting their grieving process. (+info)
Necropsies in African children: consent dilemmas for parents and guardians.
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BACKGROUND: Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS: To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS: A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS: Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a "waste of time," as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS: It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services. (+info)
Consent to autopsy for neonates.
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OBJECTIVES: To determine parents' views on autopsy after treatment withdrawal. DESIGN: Face to face interviews with 59 sets of bereaved parents (108 individual parents) for whose 62 babies there had been discussion of treatment withdrawal. RESULTS: All except one couple were asked for permission for postmortem examination; 38% refused. The main reasons for declining were concerns about disfigurement, a wish to have the child left in peace, and a feeling that an autopsy was unnecessary because the parents had no unanswered questions. The diagnosis, the age of the child, and the approach of the consultant appeared to influence consent rates. Of those who agreed to autopsies, 92% were given the results by the neonatologist concerned. Whether or not they had agreed to the procedure, at 13 months no parent expressed regrets about their decision. CONCLUSIONS: Autopsy rates in the East of Scotland stand at 62%. Parents' perceptions are an important element in consent to postmortem examination. (+info)
Lingering death after treatment withdrawal in the neonatal intensive care unit.
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OBJECTIVE: To explore parents' perceptions of treatment withdrawal and the dying process. DESIGN: Face to face interviews with 59 sets of parents of 62 babies in the East of Scotland three months and 13 months after death. RESULTS: 22% of the parents expressed reservations about the length of the dying process, which they reported in these instances had taken from three to 36 hours. Deaths that medical teams had predicted would be quick had, according to the parents' recollections, taken from 1.5 to 31 hours. When a baby died swiftly, this seemed to confirm the wisdom of the decision to stop. When babies lingered, doubts were raised. CONCLUSIONS: Parents need to be adequately prepared for what may happen after treatment withdrawal. The debate should be reopened about the best way to manage protracted deaths in line with parental need. (+info)