Hospice and euthanasia in The Netherlands: an ethical point of view.
This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. (+info)
The National Home and Hospice Care Survey: 1996 summary.
OBJECTIVE: This report presents data about agencies providing home and hospice care, their current patients, and their discharges. The data are presented in 159 tables according to standard sets of descriptive variables. The tables are grouped into five categories: agencies, home health care current patients, home health care discharges, hospice care current patients, and hospice care discharges. Data are presented on agency characteristics, demographic characteristics, utilization measures, and health and functional status of current patients and discharges. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of home health and hospice care agencies in the United States. The data were collected by personal interview using three questionnaires and two sampling lists. (+info)
Is care of the dying improving? The contribution of specialist and non-specialist to palliative care.
OBJECTIVES: To identify and synthesize evidence from studies examining the quality of care of dying patients in both specialist and general practitioner care. METHOD: Review of published research identified by online and manual searches. RESULTS: Three large, population-based surveys were identified, carried out between 1969 and 1990, and five randomized controlled trials of specialist palliative care programmes. There were, in addition, a small number of comparative studies and a large volume of descriptive, qualitative material. Some studies identified major methodological problems and the overall quality was poor. Most research concerned selected patients with neoplasms, particularly in settings where specialist palliative care teams are available. There was minimal information about the care of patients dying from non-neoplastic conditions. CONCLUSIONS: There is limited evidence of improvements in the care of selected cancer patients, and a dearth of evidence concerning patients dying from other, more common causes. The methods of research used to date are of limited current utility and new methods are required. (+info)
Experiences of older women with cancer receiving hospice care: significance for physical therapy.
BACKGROUND AND PURPOSE: The number of older adults with cancer is growing, increasing the need for professionals who are able to meet these patients' special needs. In palliative care settings, physical therapists strive to promote quality of life. Minimal research exists, however, to guide therapists working with patients with terminal illness. The purpose of this study was to gain knowledge that can be used by physical therapists to more effectively assess and treat older people with cancer receiving hospice care. SUBJECTS AND METHODS: A qualitative single-case study with replication was conducted with 3 older women with cancer who were receiving hospice care. Interview data were analyzed using grounded theory techniques. RESULTS: Four themes emerged as central to the experience of the informants: social relationships, spirituality, outlook on mortality, and meaningful physical activity. CONCLUSION AND DISCUSSION: In addition to maintaining physical function, physical therapists, who attend to nonphysical as well as physical aspects of care, may foster social cohesion, help maximize life's meaning, and support stabilizing strategies of older women with cancer who receive hospice care. (+info)
Long-term continuum of care for people living with HIV/AIDS.
The introduction of highly active antiretroviral therapy (HAART), has created new options for those infected and affected by human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS). Most HIV-infected persons no longer die within months of diagnosis. There is now a long-term continuum of care that can end in misery or relative comfort. The introduction of palliative care in concert with curative therapies throughout the disease trajectory should be the standard of care for all persons. At the very least, the introduction of palliative care and hospice at the end of life is important to the holistic care of persons living with HIV/AIDS. (+info)
Ethical dilemmas in palliative care: a study in Taiwan.
OBJECTIVES: To investigate the incidence and solution of ethical dilemmas in a palliative care unit. DESIGN: Health care workers recorded daily all dilemmas in caring for each patient. SETTING: Palliative care unit of National Taiwan University Hospital in Taiwan. PATIENTS: Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. MAIN MEASUREMENT: Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. RESULTS: The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). CONCLUSIONS: The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care. (+info)
Patients with cancer referred to hospice versus a bridge program: patient characteristics, needs for care, and survival.
PURPOSE: The purpose of this study was to compare the characteristics and needs of patients with advanced cancer who were referred to hospice with those referred to a prehospice "bridge" program that is staffed by hospice nurses. PATIENTS AND METHODS: Data were gathered through retrospective review of computerized clinical records using precoded data fields of 284 patients with cancer enrolled in a bridge program and 1,000 who enrolled in a hospice program. Patient characteristics, needs for supportive care at the time of enrollment, and survival were assessed. RESULTS: Bridge patients were less likely to have Medicare or Medicaid (43% v 72%; odds ratio, 0.30; P <.001) and were younger (69 v 73 years, rank sum test; P <.001), more likely to be married (59% v 43%; odds ratio, 1.90; P <.001), and more likely to be in the highest income category (14% v 10%; odds ratio, 1.77; P =.009). Bridge patients had at least as many needs for care as did patients in hospice. Bridge patients lived significantly longer (median, 46 v 19 days; log-rank test of survivor functions, P <.001). CONCLUSION: Patients referred to this bridge program had prognoses that are significantly better than those of patients who enter hospice, but they have needs for supportive care that are at least as great. These findings underscore the importance of initiatives to extend some of the benefits of hospice care to a wider population of patients and should encourage the analysis of similar programs' ability to meet these needs. (+info)
Home care: what a physician needs to know.
When elderly patients might benefit from home care, a key question is whether Medicare will pay for it. We describe what physicians can do to avoid the pitfalls in qualifying appropriate patients for Medicare's Home Health Services and hospice programs, and the basic features of these two programs. We also describe the experience and methods used in prototype programs that provide home-based hospital-level care, and that revive a supposedly lost art: physician house calls. (+info)