Advance directives: patient preferences in family practice.
(34/156)
The author reports on six months' experience of obtaining advance directives from patients for care in a family practice. Patients were questioned about their preferences for comfort or prolonging life and then were asked to delegate a substitute decision maker. Of 20 patients, all who responded chose comfort over prolonging life. Delegated substitute decision makers included spouses, children, and professionals or friends. In this population, patients overwhelmingly favoured comfort over prolonging life in the event that they might be irreversibly disabled, and they tended to choose spouses or other first-degree relatives as substitute decision makers. (+info)
Record health care directives before terminal illness!
(35/156)
Physicians share the grief and tension of families who must make decisions for incompetent, dying members. The author recorded the wishes of 1000 competent patients to guide families and the health care team during terminal illness. A questionnaire, which became part of the medical record, was used to determine views of organ donation, religious beliefs, and other directives. Patients were eager to record and discuss their wishes during an office or hospital visit; 94% of all patients wanted to participate in health care decisions. When directives for terminal care are available, families will not be forced to make blind crisis decisions for a dying member. (+info)
Artificial feeding for severely disoriented, elderly patients.
(36/156)
The issue of artificial feeding for patients with dementia who refuse feeding by hand is a wrenching emotional problem that can cloud clinical judgement. It is helpful to apply an analytic approach to decision making. There are five steps: gathering a comprehensive clinical database; defining the goal of treatment; knowing the treatment options available, their burdens and potential benefits; understanding the law; and defining the moral framework in which care is being given. Such an approach can be used to formulate a plan of treatment in the best interests of incompetent elderly patients who cannot speak for themselves. (+info)
Patients who want to die: a survey.
(37/156)
Representative samples of Ontario physicians and nurses, plus first and fourth year medical and nursing students in Kingston, were surveyed concerning experiences with and attitudes toward patients who want to die.Many respondents had been asked by some hopelessly ill patients for help in hastening death. Over 25 percent had known at least one such patient commit suicide. Abstention from food and drink was a common method in such suicides, and was frequently thwarted by forced feeding.A majority of respondents were definitely in favor of legal and social changes to permit compliance with requests from hopelessly ill patients for no forced feeding when the patient stopped eating, and for withdrawal of life-supporting procedures, but a solid majority opposed changes to permit compliance with requests for lethal drugs. Student respondents were neither consistently more nor consistently less favorable toward these changes than practitioners. (+info)
Patients who want to die: a survey of 1000 adults.
(38/156)
A representative sample of 1000 Ontario adults was surveyed by mail about: 1. their opinion on the desirability of legal and social changes to permit physicians to comply with requests by adult, hopelessly ill patients for measures to hasten their death, and 2. what they would prefer to do if ever faced with hopeless illness.A MAJORITY: a. favors changes to permit a doctor to carry out requests for withdrawing life-supporting equipment; b. favors rewording the law to clarify that it is legal for a doctor to carry out requests not to use forced feeding when patients refuse food; c. is against changes to permit a doctor to carry out requests for lethal drugs; d. feels that if faced with hopeless illness, they would choose to bring about their death, rather than carrying on as best as they could. (+info)
Creation of a neonatal end-of-life palliative care protocol.
(39/156)
OBJECTIVE: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support. STUDY DESIGN: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period. RESULTS/CONCLUSION: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of life-extending interventions; family follow-up care; and necessary ongoing staff support. (+info)
Comment on Re B (Adult: Refusal of Medical Treatment) [2002] 2 All England Reports 449.
(40/156)
The judgment handed down in the case of Ms B confirms the right of the competent patient to refuse medical treatment even if the result is death. The case does, however, raise some interesting legal points. The facility for conscientious objection by doctors has not previously been explicitly recognised in case law. More importantly perhaps is that the detailed inquiry by the court into Ms B's reasons for refusing treatment, apparently as a precondition for finding her competent, seems to contradict earlier case law where it has been asserted that competent patients can refuse treatment for no reason at all. (+info)