scholarly journals Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine

2021 ◽  
Author(s):  
Felicitas Selter ◽  
Kirsten Persson ◽  
Johanna Risse ◽  
Peter Kunzmann ◽  
Gerald Neitzke
Keyword(s):  
Veterinary Medicine ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Good Death ◽  
Life Care ◽  
Negative Consequences ◽  
Pet Owners ◽  
Recent Developments ◽  
The One

AbstractStandard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be ‘put to sleep’, while veterinarians have begun to integrate principles and practices from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the (dis)analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the (animal and human) patients’ wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Serious Mental Illness and Hospice Care

2021 ◽  
pp. 082585972110220
Author(s):  
Gwen Levitt
Keyword(s):  
Mental Health ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychiatric Illness ◽  
Hospice Care ◽  
Treatment Options ◽  
Life Care ◽  
Case Review ◽  
Health Community ◽  
End Stage

There are a small number of articles in the literature discussing palliative and end-of-life care in the SMI population. Most tackle the questions relating to competency to refuse care in end-stage anorexia or terminal medical conditions. This is a case review of a 55 year old patient with a complex psychiatric and medical history, who despite extensive treatment and long hospitalizations has failed to regain any ability to care for her basic needs. She has exhausted all available treatment options and her prognosis is extremely poor. The mental health community is resistant to discussing and/ or confronting the fact that such a patient faces with the need for end-of-life care directly related to chronic psychiatric illness.

scholarly journals When Conscience Wavers. Some Reflections on the Normalization of Euthanasia in Belgium

2021 ◽  
pp. 25-37
Author(s):  
Willem Lemmens
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Psychiatric Patients ◽  
Therapeutic Option ◽  
Good Death ◽  
Life Care ◽  
Philosophical Perspective ◽  
Established Fact ◽  
The Law

AbstractIn this chapter, I evaluate from a philosophical perspective the ongoing discussions in the Belgian civil society triggered by the euthanasia law and its implementation in end-of-life care since 2002. I challenge the idea that the so-called normalization of euthanasia is an established fact and I contend that the ongoing discussions on the possible abuses of the law and the practice of euthanasia are unavoidable. I see three reasons for this. First, in contrast with what some think, euthanasia can never become a “normal” therapeutic option, that could be integrated in standard medical practice. Euthanasia is, by its very nature, a transgression of a fundamental moral taboo and will thus always, however liberal the law might be, challenge the conscience of some physicians. Secondly, because of its transgressive meaning, every act of euthanasia can always be contested by family members or the larger society. This is the case when euthanasia is given to patients who are not terminally ill (such as psychiatric patients), but also when a physician performs euthanasia in an undignified and negligent way. Thirdly, the very existence of the law puts pressure not only on patients and physicians but also the larger society. By making euthanasia into a symbol of the good death, a whole society loses its sensitivity for the intrinsic transgressive nature of euthanasia and creates all sorts of strategies to mask the wavering of conscience that results from this collective negligence. There is no way, so I conclude, to avoid this. The wavering of conscience will continue to haunt the end-of-life care in Belgium as long as the law on euthanasia remains as it is.

Opposing Vitalism and Embracing Hospice: How a Theology of the Sabbath Can Inform End-of-Life Care

2021 ◽  
Author(s):  
Sarah K Sawicki
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Modern Medicine ◽  
The Body ◽  
Care Plan ◽  
Life Care ◽  
Negative Effects ◽  
Whole Person

Abstract Medicine often views hospice care as “giving up,” which results in a reduced quality of end-of-life care for many patients. By integrating a theology of the Sabbath with modern medicine, hospice becomes a sacred and valuable way to honor the dying patient in a comprehensive and holistic way. A theology of Sabbath as “Sacredness in Time” can provide the foundation for a shift in understanding hospice as a legitimate care plan, which shifts the focus from controlling and manipulating space for the body, to rest and enjoyment of time for the whole person. First, I explore vitalism and its negative effects on the institution of hospice. Second, I address the main misconceptions and biases surrounding hospice in order to establish hospice as an appropriate option for the terminally ill. Finally, I argue for a shift away from sacredness in space (as seen in vitalism) to sacredness in time.

Sexuality

2015 ◽  
pp. 410-421
Author(s):  
Marianne Matzo
Keyword(s):  
Sexual Health ◽  
End Of Life ◽  
Sexual Functioning ◽  
End Of Life Care ◽  
Life Care ◽  
Leading Role ◽  
Significant Difference ◽  
The One

Healthcare practitioners should assume a leading role in the assessment and remediation of potential or identified alterations in sexual functioning. Not all couples will be concerned about their sexual health at this point of their life together. However, people may find that being physically close to the one they love is life-affirming and comforting. Assessment of sexual health should occur for all patients to determine whether these needs and hopes include maintenance of their sexual health. The healthcare practitioner’s offer of information and support can make a significant difference in a couple’s ability to adjust to the changes in sexual health during end-of-life care.

What is a good death? A critical discourse policy analysis

2020 ◽  
pp. bmjspcare-2019-002173
Author(s):  
Erica Borgstrom
Keyword(s):  
Discourse Analysis ◽  
Critical Discourse Analysis ◽  
End Of Life ◽  
End Of Life Care ◽  
Critical Discourse ◽  
Good Death ◽  
Complex Nature ◽  
Life Care ◽  
Advance Care ◽  
Motivating Factor

ObjectiveThe concept of a good death is a motivating factor for end of life care policy; this article examines what English end-of-life care (EOLC) policy defines as a good death.MethodsCritical discourse analysis of policy documents and policy-promoting materials published between 2008 and 2016.ResultsPolicy explicitly defines a good death as having the following attributes: being treated as an individual, with dignity and respect; being without pain and other symptoms; being in familiar surroundings and being in the company of close family and/or friends. Critical discourse analysis of 54 documents found that rather than just being an outcome or event, descriptions of what makes a death good also include many processes. A more extended definition includes: the person receives holistic EOLC; the dying person is treated with dignity and respect; the death is not sudden and unexpected; people are prepared and have ideally done some advance care planning; people are aware that someone is dying and openly discuss this; on knowing the dying person’s preferences, all involved are to work towards achieving these; the place of death is important; the person’s family are involved and the needs of the bereaved are considered.ConclusionThis analysis indicates the complex nature of the current discourses around good death in EOLC policy, which often focuses on care rather than death. Policy should focus on outlining what quality end-of-life care looks like, rather than assume ‘good death’ is a suitable outcome statement.

Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions

2020 ◽  
Vol 16 (12) ◽  
pp. 803-809
Author(s):  
Mihir N. Patel ◽  
Jonathan M. Nicolla ◽  
Fred A.P. Friedman ◽  
Michala R. Ritz ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Hospice Care ◽  
Rapid Development ◽  
Spiritual Needs ◽  
Life Care ◽  
General Acceptance ◽  
Patients With Cancer ◽  
Hospice Use

Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients’ biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.

scholarly journals CAREGIVER BURDEN, BENEFIT, AND PERCEPTIONS OF END-OF-LIFE CARE QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S668-S668
Author(s):  
Elizabeth A Luth ◽  
Teja Pristavec
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Quality Care ◽  
Care Quality ◽  
National Study ◽  
Life Care ◽  
Care Needs ◽  
Caregiving Burden ◽  
High Burden

Abstract End-of-life care quality (EOLCQ) gauges our success in providing quality care to dying individuals. EOLQC measures rely on reports from bereaved family members who provide care for dying loved ones, but analyses seldom account for how caregivers’ experiences influence their EOLCQ perceptions. Caregivers frequently experience burden, which is linked to poor health outcomes and may negatively bias EOLCQ reports. Individuals may also perceive caregiving benefits that can offset deleterious burden effects, but potentially encourage overly positive EOLCQ perceptions. This paper links National Study of Caregivers (2011) and National Health and Aging Trends Study (2011-2016) data, using regression analysis and a sample of 380 EOL caregivers to examine how caregiving burden and benefits perceptions shape and moderate EOLCQ reports. Caregiving burden is unrelated to EOLCQ in adjusted models. Benefits are associated with marginally greater odds of being informed about the dying person’s condition and reporting their personal care needs were met. Burden and benefits moderate these two measures. Despite benefits, low burden caregivers report they were informed about the dying person’s condition with 90% probability. Regardless of burden, high benefits caregivers report the same with 90% probability. Low burden and benefits caregivers report met care needs with 90% probability. High burden and benefits caregivers have 90% probability of such reports. Given these reports are used in formal hospice care evaluations by CMS, additional research should explore why caregiving burden and benefit are associated with some EOLCQ measures and why individuals reporting high burden and benefits provide more positive EOLCQ appraisals.

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