Introduction

2021 ◽  
pp. 1-16
Keyword(s):  
Terminal Illness ◽  
Patient Choice ◽  
Death Certificates ◽  
Severe Dementia ◽  
Caregiver Support ◽  
Medical Assistance In Dying ◽  
Pragmatic Analysis ◽  
Decision Making Capacity ◽  
Wide Range ◽  
Life Options

Voluntary stopping eating and drinking (VSED), though relatively unknown and poorly understood, is a widely available option for hastening death. VSED is legally permitted in places where medical assistance in dying (MAID) is not, and unlike U.S. jurisdictions where MAID is legally permitted, VSED is not limited to terminal illness or to those with current decision-making capacity. With adequate clinician and caregiver support, VSED is a compassionate option that respects patient choice. Moreover, the practice is not limited to avoiding unbearable suffering, but may also be used by those who are determined not to live long with unacceptable deterioration such as severe dementia. Despite the misleading image of “starvation,” death by VSED can typically be peaceful and meaningful when accompanied by adequate clinician/caregiver support. VSED is, however, “not for everyone,” and this volume provides a realistic, appropriately critical as well as supportive assessment of the practice. Eight illustrative, previously unpublished real cases are included, receiving pragmatic analysis in each chapter. The volume’s integrated, multi-professional, multidisciplinary character makes it useful for a wide range of readers: patients considering end-of-life options and their families, clinicians of all kinds, ethicists, lawyers, and institutional administrators. Appendices include recommended elements of an advance directive for stopping eating and drinking and what to record as cause of death on the death certificates for those who hasten death by VSED.

Voluntarily Stopping Eating and Drinking

2021 ◽  
Keyword(s):  
Terminal Illness ◽  
Patient Choice ◽  
Medical Assistance ◽  
Severe Dementia ◽  
Caregiver Support ◽  
Medical Assistance In Dying ◽  
Pragmatic Analysis ◽  
Decision Making Capacity ◽  
Wide Range ◽  
Life Options

Voluntary stopping eating and drinking (VSED), though relatively unknown and poorly understood, is a widely available option for hastening death. VSED is legally permitted in places where medical assistance in dying (MAID) is not, and unlike U.S. jurisdictions where MAID is legally permitted, VSED is not limited to terminal illness or to those with current decision-making capacity. With adequate clinician and caregiver support, VSED is a compassionate option that respects patient choice. Moreover, the practice is not limited to avoiding unbearable suffering, but may also be used by those who are determined not to live long with unacceptable deterioration such as severe dementia. Despite the misleading image of “starvation,” death by VSED can typically be peaceful and meaningful when accompanied by adequate clinician/caregiver support. VSED is, however, “not for everyone,” and this volume provides a realistic, appropriately critical as well as supportive assessment of the practice. Eight illustrative, previously unpublished real cases are included, receiving pragmatic analysis in each chapter. The volume’s integrated, multi-professional, multidisciplinary character makes it useful for a wide range of readers: patients considering end-of-life options and their families, clinicians of all kinds, ethicists, lawyers, and institutional administrators. Appendices include recommended elements of an advance directive for stopping eating and drinking and what to record as cause of death on the death certificates for those who hasten death by VSED.

scholarly journals QOLP-26. USE OF MEDICAL ASSISTANCE IN DYING (“DEATH WITH DIGNITY”) IN WASHINGTON STATE PATIENTS WITH BRAIN TUMORS.

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii180-ii180
Author(s):  
Jerome Graber ◽  
Kaite Sofie ◽  
Lynne Taylor
Keyword(s):  
Brain Tumors ◽  
Terminal Illness ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
High Grade Glioma ◽  
Washington State ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Medical Assistance In Dying ◽  
Diagnosis Of Cancer

Abstract Since 2009, Washington State has had a “Death with Dignity” (DWD) process whereby people with a terminal illness may legally obtain a prescription for medications that will end their life. Patients initiate a voluntary request from two physicians certifying they have a prognosis < 6 months, are aware of other palliative care options, and have capacity without the comorbidity of a psychiatric diagnosis. Since 2015, over 200 people annually have used the DWD process in Washington. Other papers have described the characteristics of people using DWD with a diagnosis of cancer or amyotrophic lateral sclerosis (ALS) but none have specifically looked at patients with brain tumors (BT) who used DWD. We describe 20 people with BT who accessed DWD since 2015 at our center. Median age at the time of death was 51 (range 38-79) and 75% were men. Glioblastoma was the diagnosis in 10 (50%), anaplastic glioma in 8 (40%), grade II astrocytoma in 1, and a presumed high-grade glioma by imaging in 1. Median Karnofsky Performance Status (KPS) was 90 at diagnosis (range 50-100) and 70 at DWD request (range 40-90). Standard radiation (RT) and chemotherapy was used by 17 (85%) prior to DWD request, while 3 patients (15%, ages 70-79, KPS 50-90) requested DWD immediately after diagnosis and did not undergo further treatment. Pain was present in 4 patients (20%), 2 using opioids (10%). Six patients (30%) continued tumor treatments after approval for DWD. Median OS was 22 months (range 2-285) and 24 months excluding patients who declined treatment (range 8-285). Most glioma patients in our cohort requested DWD after undergoing chemoradiation, pain was uncommon and rarely severe, and survival from diagnosis was comparable to standard therapy. As access to medical assistance in dying continues, further research is needed on its utilization for people with brain tumors.

Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis

2021 ◽  
pp. 147775092110698
Author(s):  
Alexia Zagouras ◽  
Elise Ellick ◽  
Mark Aulisio
Keyword(s):  
Decision Making ◽  
Young Adults ◽  
Medical Decision Making ◽  
Life Experience ◽  
Pregnant Patient ◽  
Medical Decision ◽  
Individual Autonomy ◽  
Caregiver Support ◽  
Neurological Condition ◽  
Decision Making Capacity

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.

The EMDR Integrative Group Treatment Protocol for Patients With Cancer

2016 ◽  
Vol 10 (3) ◽  
pp. 199-207 ◽  
Author(s):  
Ignacio Jarero ◽  
Lucina Artigas ◽  
Susana Uribe ◽  
Laura Evelyn García
Keyword(s):  
Stress Responses ◽  
Traumatic Stress ◽  
Group Treatment ◽  
Terminal Illness ◽  
Treatment Protocol ◽  
Individual Treatment ◽  
Adult Women ◽  
Patients With Cancer ◽  
Wide Range ◽  
Adolescents And Adults

Experiencing cancer is a peculiar stressor within the infrastructure of posttraumatic stress disorder (PTSD) because this debilitating disease involves ongoing stressors and is both acute and potentially chronic. The experience can include a wide range of associated adverse events, such as tumor detection, diagnosis, severity of disease, and prognosis; aggressive treatment; disfigurement and bodily dysfunction; side effects of treatment; impaired physical, social, and occupational functioning; and sometimes, recurrence and diagnosis of terminal illness. This article provides a detailed description of the clinical application of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) Adapted for Adolescents and Adults Living with Ongoing Traumatic Stress for the patients with cancer. This protocol administers the eight phases of EMDR individual treatment to a group of patients using an art therapy format (i.e., drawings) and the butterfly hug (a self-administered bilateral stimulation method to process traumatic material). A previous study (Jarero et al., 2015) showed that after 6 sessions of EMDR-IGTP, there was a significant decrease in PTSD symptoms related to the diagnosis and treatment of different types of cancer in adult women. Effects were maintained at 90-day follow-up. In this article, we discuss how this protocol can be used to effectively provide intensive EMDR treatment to large groups of patients, and we provide detailed instructions for its provision to address one of the major psychological dimensions of cancer: the ongoing traumatic stress responses experienced by patients with cancer. A clinical example illustrates the treatment process.

scholarly journals P009: Medical assistance in dying – a survey of Canadian emergency physicians

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S66
Author(s):  
F. Bakewell
Keyword(s):  
Emergency Medicine ◽  
Terminal Illness ◽  
Free Form ◽  
Medical Attention ◽  
Emergency Physicians ◽  
Medical Assistance ◽  
Electronic Survey ◽  
Medical Assistance In Dying ◽  
Self Harm ◽  
The Impact

Introduction: There have been 3714 medically assisted deaths recorded in Canada so far, with more than half of those deaths occurring outside the hospital – whether this has had any impact on emergency medicine has not yet been documented. This survey sought to find out Canadian emergency physicians’ (EPs) attitudes and experiences with medical assistance in dying (MAID). Methods: An electronic survey was distributed to CAEP members using a modified Dillman technique. The primary outcome was defined as the proportion of EPs in favour of MAID. Secondary outcomes included experience with suicide in the setting of terminal illness, their experience and opinion on referring patients for MAID from the ED, their experience with complications of MAID, and their response to hypothetical cases of complications from MAID. Nominal variables were analyzed and reported as percentages for each relevant answer. Answers submitted as free-form text were coded into themes by the author and reported based on these themes. Results: There were 303 completed surveys. EPs were largely in support of MAID (80.5%), and would be willing to refer patients for assessment from the ED (83.2%), however fewer (58.3%) knew how to do so. 37.1% of EPs had been asked for a referral for MAID assessment, but only 12.5% had made a referral. While only 1% of EPs reported having seen patients present with complications from MAID (failed IVs in the community), 5.0% had seen patients present with suicide or self-harm attempts after being told they were ineligible for MAID by another provider. Conclusion: This is the first study to examine the impact of MAID on emergency medicine in Canada, and it demonstrates that patients are both requesting referrals through the ED and, in rare cases, requiring medical attention for complications. This has implications for both increasing awareness of MAID referral processes for EPs, as well as for the prevention and treatment of complications of MAID in the community.

‘I wouldn’t think you might agree’

2009 ◽  
Vol 2 (1) ◽  
pp. 18-47
Author(s):  
Marta Degani ◽  
Anna Belladelli
Keyword(s):  
Point Of View ◽  
Modal Verbs ◽  
Qualitative And Quantitative ◽  
Communicative Strategies ◽  
Pragmatic Analysis ◽  
Syntactic Pattern ◽  
Wide Range ◽  
Modal Verb ◽  
Communicative Context

This study concerns objectivity, subjectivity and intersubjectivity in relation to the English central modal verbs. In order to refine the (inter)subjective status of modals from a synchronic perspective, it focuses on their possible uses within a specific communicative context where the SP/W needs to ‘modulate’ his/her own and/or other people’s point of view. A qualitative and quantitative corpus-based analysis has been carried out on the syntactic pattern Subject + Modal Verb + Mental Verb, to check whether and to what extent (inter)subjectivity occurs in the written medium. By means of a semantic-pragmatic analysis of the central modals within the selected pattern, a wide range of communicative strategies has been observed. Four main aims have been identified that the SP/W may have in mind when choosing to resort to (inter)subjectivity: namely, the expression of the SP/W’s point of view (EPV), the shaping of the AD/R’s line of reasoning (SLR), the imposition of the SP/W’s power on the AD/R (IP), and the communication of information (CI).

scholarly journals Linguistic Means for Expressing Emotions in a Literary Text

enadakultura ◽  
2021 ◽  
Author(s):  
Nino Sarajishvili ◽  
Giorgi Kuparadze
Keyword(s):  
Literary Work ◽  
Literary Text ◽  
Practical Aspect ◽  
Basic Emotions ◽  
Pragmatic Analysis ◽  
Wide Range ◽  
State Of Mind ◽  
Inner World ◽  
Expression Of Emotions ◽  
Linguistic Means

A description of semantics is the means of expressing emotions that can be used in any literary work. We investigate and analyze the text, conduct the research of its lexical and semantic units from different dimensions.In the present paper, we deal with a complete description of the inner world of the characters in a literary work, their spiritual or emotional state of mind through the linguistic means that are used by the authors to fully display the personal images of the main characters and to perceive them thoroughly by the reader.The conducted analysis has shown that through the structural-semantic dynamics and pragmatic analysis and particular emphasis is made on the practical aspect of what type of information is realised by the addresser (character) while expressing this or that kind of emotion and how the recipient perceives this information based on the protagonist’s behaviour in a given particular case.We have foregrounded structural-semantic models of basic emotions and linguistic means containing emotions. The study of the pragmatic potential of the expression of emotions is indeed valuable for the pragmatics of a literary text, for the scrupulous understanding of various nations’ history, which inevitably reflects and will reflect in future the wide range of tasks of modern linguistics.Finally, we should also conclude that emotional load/coloring in a literary text can be represent better and perceive a characters’ cultural speech, which implies the correctness and exactness of the characters' use of the means of expressing emotions during the interaction.

Best Practices, Enduring Challenges, and Opportunities for VSED

2021 ◽  
pp. 126-130
Author(s):  
Timothy E. Quill ◽  
Paul T. Menzel ◽  
Thaddeus M. Pope ◽  
Judith K. Schwarz
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Best Practices ◽  
Advance Directives ◽  
Symptom Management ◽  
Early Phase ◽  
Terminal Illness ◽  
Care Providers ◽  
Decision Making Capacity ◽  
Challenges And Opportunities

VSED begins with excellent symptom management supported by experienced clinicians. VSED is largely patient controlled, but involvement of experienced palliative care providers and family is strongly recommended. Decision making capacity is frequently lost late in the process as death nears, so written advance directives to continue withholding food and fluids should be completed prior to initiating VSED to forestall any misunderstandings of the patient’s wishes. Challenges associated with VSED include its two week duration before death, the personal determination required, and the possibility of delirium in the latter stages that potentially compromises the commitment to forgo fluids. These challenges should be anticipated and planned for. The primary advantages of VSED include: 1) predictable two week duration from initiation to death; 2) alertness for the early phase, 3) no terminal illness requirement, 4) largely under the patient’s control, and 5) awareness of the possibility of VSED can provide comfort to those worried about unacceptable future suffering.

scholarly journals A Pragmatic Analysis of Margaret Ogola’s the River and the Source and I Swear by Apollo

2019 ◽  
Vol 1 (2) ◽  
pp. p88
Author(s):  
Nicholas Onyango Oloo ◽  
Prof. Francis OwinoRew ◽  
Dr. Robert Onyango Ochieng’
Keyword(s):  
Data Analysis ◽  
Mixed Method ◽  
Speech Acts ◽  
Speech Act ◽  
Speech Act Theory ◽  
Verbal Interactions ◽  
Pragmatic Analysis ◽  
Wide Range ◽  
Analytical Research ◽  
Conversational Turns

This paper aims at interrogating the significance of pragmatics in analyzing Margaret Ogola’s two novels; The River and the Source (1994) and I swear by Apollo (2002). The researcher analyses the characters’ conversational turns in the novels using Austin (1962) and Searle 1969 Speech Act Theory. The study employs an analytical research design using a mixed method data analysis. The findings indicate that every utterance used by a character performs three simultaneous acts namely; a locutionary, an illocutionary and perlocutionary. In addition, the data shows that every utterance produced by a character in the novels could be categorized under one of the five major categories speech acts proposed by Searle (1969); representatives, expressive, directives, commisives or declarations. The study found that the representatives are the most dominant in both novels while declarations the least. The study also reveals that each major speech act contains a wide range of sub acts or illocutionary forces which are distinguished based on their felicity conditions. The study therefore proposes that pragmatic analysis be adopted as an effective tool in the analysis of the characters’ verbal interactions in novels. In addition, further research could be conducted on pragmatic analysis of novels by other writers.

An Advance Request: The Accessibility of Medical Assistance in Dying (MAID) for Patients Who Loose Decision-Making Capacity

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Natasha Harris
Keyword(s):  
Decision Making ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Waiting Period ◽  
Medical Assistance In Dying ◽  
Decision Making Capacity

Since the legalization of Medical Assistance in Dying (MAID) in Canada in 2016, there have been discussions regarding the extension of this service to patients who lose decision-making capacity but have made a prior advance request for physician-assisted suicide. Both caregivers and physicians have shown some support for allowing patients to make advance requests for MAID. The proposed changes to the legislation would remove the mandatory 10 day waiting period and include a waiver of final consent for those who loose decision-making capacity following their MAID request.

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