Sedation for refractory symptoms

2015 ◽  
pp. 440-448
Author(s):  
Patti Knight ◽  
Laura A. Espinosa ◽  
Bonnie Freeman
Keyword(s):  
Informed Consent ◽  
Case Studies ◽  
Nursing Care ◽  
Hospital Setting ◽  
Palliative Sedation ◽  
Ethical Considerations ◽  
Time To Death ◽  
Refractory Symptoms

This chapter explores the use of palliative sedation in the hospital setting. It presents case studies involving palliative sedation, discusses several definitions of palliative sedation, frequency of palliative sedation, reasons for palliative sedation, medications used, guidelines for nursing care, time-to-death issues, ethical considerations, informed consent, and the role of the nurse-caregiver.

Informed Consent

PEDIATRICS ◽  
1967 ◽  
Vol 39 (2) ◽  
pp. 309-309
Author(s):  
H. DAVID MOSIER
Keyword(s):  
Informed Consent ◽  
Clinical Investigation ◽  
Ethical Considerations

It is difficult to imagine a physician investigator who does not also at the same time play the role of "physician-friend" in the sense of Dr. Silverman's proposal (Pediatrics, 38:373, 1966). Any physician responsible for the subjects of clinical investigation must perform his role guided by the same ethical considerations that guide other physicians in the care of their patients. Were it otherwise, the subjects would be placed at some jeopardy as to their welfare and the preservation of their dignity.

scholarly journals A review of informed consent and how it has evolved to protect vulnerable participants in emergency care research

2020 ◽  
Vol 5 (2) ◽  
pp. 73-79
Author(s):  
Rajpal Nandra ◽  
Alan F. Brockie ◽  
Faisal Hussain
Keyword(s):  
Informed Consent ◽  
Emergency Care ◽  
Ethics Committees ◽  
Moral Obligations ◽  
Ethical Considerations ◽  
Vulnerable Patients ◽  
Ethical Approval ◽  
Life Threatening ◽  
Time Critical

A vulnerable participant in research lacks capacity to consent or may be exposed to coercion to participate. Capacity may be temporarily impaired due to loss of consciousness, hypoxia, pain and the consumption of alcohol or elicit substances. To advance emergency care, providing life-threatening measures in life-threatening circumstances, vulnerable patients are recruited into research studies. The urgent need for time-critical treatment conflicts with routine informed consent procedures. This article reviews ethical considerations and moral obligations to safeguard these participants and preserve their autonomy. A particular focus is given to research methodology to waive consent, and the role of ethics committees, research audits, research nurses and community engagement. Research on the acutely unwell patient who lacks capacity is possible with well-designed research trials that are led by investigators who are sufficiently trained, engage the community, gain ethical approval to waive consent and continuously audit practice. Cite this article: EFORT Open Rev 2020;5:73-79. DOI: 10.1302/2058-5241.5.180051

The Use of Palliative Sedation to Treat Existential Suffering: A Scoping Review on Practices, Ethical Considerations, and Guidelines

2019 ◽  
Vol 35 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Allysa L. Ciancio ◽  
Raza M. Mirza ◽  
Amy A. Ciancio ◽  
Christopher A. Klinger
Keyword(s):  
Health Care ◽  
Scoping Review ◽  
Research Policy ◽  
Grey Literature ◽  
Palliative Sedation ◽  
Ethical Considerations ◽  
Policy And Practice ◽  
Refractory Symptoms ◽  
Existential Suffering ◽  
The Impact

Context: Though palliative sedation has been recognized as an acceptable practice in Canada for many years now, there is a lack of clinical research and guidelines pertaining to its use as a treatment of existential refractory symptoms in the terminally ill. Objectives: This scoping review aimed to survey the literature surrounding palliative sedation and existential suffering and to inform research, policy, and practice. Methods: To address the main research question: Is palliative sedation an acceptable intervention to treat existential refractory symptoms in adults aged 65 and older? a scoping review following Arksey and O’Malley’s framework was performed, spanning electronic databases of the peer reviewed and grey literature. Articles were screened for inclusion, and a thematic content analysis allowed for a summary of key findings. Results: Out of 427 search results, 71 full text articles were obtained, 20 of which were included. Out of these articles, four themes were identified as key findings. These included: (1) Ethical considerations; (2) The role of the health care provider; looking specifically at the impact on nurses; (3) The need for multidisciplinary care teams; and (4) Existential suffering’s connection to religiosity and spirituality. Conclusion: Palliative sedation to treat existential refractory symptoms was labelled a controversial practice. A shortage of evidence-based resources limits the current literature’s ability to inform policy and clinical practice. There is a need for both qualitative and quantitative multi-center research so health care professionals and regional-level institutions have firm roots to establish proper policy and practice.

Ethical Conduct of Clinical Trials, Institutional Review Boards, Informed Consent, and Financial Conflicts of Interest

2017 ◽  
Author(s):  
Christian B. Ramers
Keyword(s):  
Informed Consent ◽  
Conflicts Of Interest ◽  
Institutional Review Boards ◽  
Ethical Considerations ◽  
Governmental Organizations ◽  
Institutional Review ◽  
The Us ◽  
Guidelines And Recommendations ◽  
Study Designs

Ethics and conflicts of interest are important considerations when planning and carrying out research. It is the role of the institutional review board to weigh these against protection of the research subject when evaluating research proposals. The ethical considerations when performing research include basic ethical principles (e.g., autonomy, confidentiality, non-maleficence, informed consent, beneficence, justice, and utility), as well as nuances such as appropriate study designs, investigator conflict of interests, and bias in all its forms. To help guide clinicians, a number of professional and governmental organizations have published guidelines and recommendations on various aspects of clinical research (e.g., the American Medical Association, the National Institutes of Health, and the US Food and Drug Administration).

Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations

2017 ◽  
Vol 26 (1) ◽  
pp. 84-95 ◽  
Author(s):  
Pamela Bjorklund ◽  
Denise M Lund
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Hospital Setting ◽  
Ethical Considerations ◽  
Communicative Skills ◽  
Code Status ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Patients often are confronted with the choice to allow cardiopulmonary resuscitation (CPR) should cardiac arrest occur. Typically, informed consent for CPR does not also include detailed discussion about survival rates, possible consequences of survival, and/or potential impacts on functionality post-CPR. Objective: A lack of communication about these issues between providers and patients/families complicates CPR decision-making and highlights the ethical imperative of practice changes that educate patients and families in those deeper and more detailed ways. Design: This review integrates disparate literature on the aftermath of CPR and the ethics implications of CPR decision-making as it relates to and is affected by informed consent and subsequent choices for code status by seriously ill patients and their surrogates/proxies within the hospital setting. Margaret Urban Walker’s moral philosophy provides a framework to view informed consent as a practice of responsibility. Ethical considerations: Given nurses’ communicative skills, ethos of care and advocacy, and expertise in therapeutic relationships, communication around DNAR decision-making might look quite different if institutional norms in education, healthcare, law, and public policy held nurses overtly responsible for informed consent in some greater measure. Findings: Analysis from this perspective shows where changes in informed consent practices are needed and where leverage might be exerted to create change in the direction of deeper and more detailed discussions about CPR survival rates and possible consequences of survival.

Striving for good nursing care

2014 ◽  
Vol 21 (8) ◽  
pp. 902-915 ◽  
Author(s):  
Mona Pettersson ◽  
Mariann Hedström ◽  
Anna T Höglund
Keyword(s):  
Nursing Care ◽  
Specific Role ◽  
Ethical Review ◽  
Do Not Resuscitate ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Qualitative Descriptive ◽  
Do Not Resuscitate Orders

Background: Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce. Objective: The aim of this study was to investigate hematology and oncology nurses’ experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses’ specific role in these decisions. Research design: A qualitative, descriptive methodology with individual semi-structured interviews was used. Participants and research context: A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually. Ethical considerations: In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration. Findings: The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties. Conclusion: In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other’s opinions within the medical team, regular ethical discussions are required.

Track 2.a Introduction

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sucharita BENIWAL ◽  
Sahil MATHUR ◽  
Lesley-Ann NOEL ◽  
Cilla PEMBERTON ◽  
Suchitra BALASUBRAHMANYAN ◽  
...  
Keyword(s):  
Case Studies ◽  
Local Knowledge ◽  
Ways Of Knowing ◽  
Social Contexts ◽  
Knowledge Systems ◽  
Theoretical Frameworks ◽  
Native Communities ◽  
Cultural Systems ◽  
Local Practices

The aim of this track was to question the divide between the nature of knowledge understood as experiential in indigenous contexts and science as an objective transferable knowledge. However, these can co-exist and inform design practices within transforming social contexts. The track aimed to challenge the hegemony of dominant knowledge systems, and demonstrate co-existence. The track also hoped to make a case for other systems of knowledges and ways of knowing through examples from native communities. The track was particularly interested in, first, how innovators use indigenous and cultural systems and frameworks to manage or promote innovation and second, the role of local knowledge and culture in transforming innovation as well as the form of local practices inspired innovation. The contributions also aspired to challenge through examples, case studies, theoretical frameworks and methodologies the hegemony of dominant knowledge systems, the divides of ‘academic’ vs ‘non-academic’ and ‘traditional’ vs ‘non-traditional’.

Sign in / Sign up

Export Citation Format

Share Document