Ethical Considerations (Conflict of Interest, Surgical Innovation, and End of Life)

2021 ◽  
pp. 1127-1138
Author(s):  
W. Donald Buie ◽  
Anthony R. MacLean
Keyword(s):  
End Of Life ◽  
Conflict Of Interest ◽  
Ethical Considerations ◽  
Surgical Innovation

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

2018 ◽  
Vol 45 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Lori Seller ◽  
Marie-Ève Bouthillier ◽  
Veronique Fraser
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Retrospective Chart Review ◽  
Median Number ◽  
Life Care ◽  
Ethical Considerations ◽  
Term Care ◽  
Medical Aid ◽  
Aid In Dying

BackgroundMedical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

scholarly journals Deep Brain Stimulation at End of Life: Clinical and Ethical Considerations

2020 ◽  
Vol 23 (4) ◽  
pp. 582-585
Author(s):  
Lauren R. Sankary ◽  
Paul J. Ford ◽  
Andre G. Machado ◽  
Laura J. Hoeksema ◽  
Renato V. Samala ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
End Of Life ◽  
Brain Stimulation ◽  
Ethical Considerations ◽  
Deep Brain

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
pp. 2019-2037 ◽  
Author(s):  
Peter M. Eckman ◽  
Jason N. Katz ◽  
Aly El Banayosy ◽  
Erin A. Bohula ◽  
Benjamin Sun ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
End Of Life ◽  
Pediatric Population ◽  
Adult Patients ◽  
Ethical Considerations ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Failure ◽  
Practical Management ◽  
Exit Strategies

Extracorporeal membrane oxygenation has evolved, from a therapy that was selectively applied in the pediatric population in tertiary centers, to more widespread use in diverse forms of cardiopulmonary failure in all ages. We provide a practical review for cardiovascular clinicians on the application of veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock, including epidemiology of cardiogenic shock, indications, contraindications, and the extracorporeal membrane oxygenation circuit. We also summarize cannulation techniques, practical management and troubleshooting, prognosis, and weaning and exit strategies, with attention to end of life and ethical considerations.

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