Physician-Assisted Suicide in Context: Constitutional, Regulatory, and Professional Challenges

1996 ◽  
Vol 24 (3) ◽  
pp. 181-182
Author(s):  
Bernard Lo ◽  
Karen H. Rothenberg ◽  
Michael Vasko
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Disseminated Intravascular Coagulation ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Experimental Chemotherapy ◽  
Blood Samples ◽  
Intravascular Coagulation ◽  
Professional Challenges

Last month, a fifty-eight-year old man developed bleeding into his cheek and oozing from sites where previously he had had blood samples drawn. This bleeding was caused by disseminated intravascular coagulation, a complication of colon cancer that had spread to his liver and lungs. This complication occurred even though he was on chemotherapy for the cancer. In the hospital, he received transfusions and was administered medicine to stop the bleeding. However, his condition did not improve. He developed more bruises. When he tried to go to the bathroom without assistance, he fell, struck his head, requiring stitches, and developed a black, swollen eye. The patient, a successful businessman, had already overcome another type of cancer—lymphoma—through chemotherapy, twenty-five years ago. In a few days, this dynamic individual who expected to start experimental chemotherapy now saw his quality of life deteriorate steadily.We talked about more chemotherapy, about hospice, and about withholding attempts at resuscitation if his heart should stop.

scholarly journals Euthanasia and suicide: a medical and social discourse

2021 ◽  
Vol 25 (1) ◽  
pp. 107-112
Author(s):  
V. N. Ostapenko ◽  
I. V. Lantukh ◽  
A. P. Lantukh
Keyword(s):  
Quality Of Life ◽  
Assisted Suicide ◽  
Human Life ◽  
Modern Science ◽  
Physician Assisted Suicide ◽  
Adequate Quality ◽  
The Subject ◽  
Strong Explosion ◽  
The Right

Annotation. The problem of suicide and euthanasia has been particularly updated with the spread of the COVID-19 pandemic, which caused a strong explosion of suicide, because medicine was not ready for it, and the man was too weak in front of its pressure. The article considers the issue of euthanasia and suicide based on philosophical messages from the position of a doctor, which today goes beyond medicine and medical ethics and becomes one of the important aspects of society. Medicine has achieved success in the continuation of human life, but it is unable to ensure the quality of life of those who are forced to continue it. In these circumstances, the admission of suicide or euthanasia pursues the refusal of the subject to achieve an adequate quality of life; an end to suffering for those who find their lives unacceptable. The reasoning that banned suicide: no one should harm or destroy the basic virtues of human nature; deliberate suicide is an attempt to harm a person or destroy human life; no one should kill himself. The criterion may be that suicide should not take place when it is committed at the request of the subject when he devalues his own life. According to supporters of euthanasia, in the conditions of the progress of modern science, many come to the erroneous opinion that medicine can have total control over human life and death. But people have the right to determine the end of their lives while using the achievements of medicine, as well as the right to demand an extension of life with the help of the same medicine. They believe that in the era of a civilized state, the right to die with medical help should be as natural as the right to receive medical care. At the same time, the patient cannot demand death as a solution to the problem, even if all means of relieving him from suffering have been exhausted. In defense of his claims, he turns to the principle of beneficence. The task of medicine is to alleviate the suffering of the patient. But if physician-assisted suicide and active euthanasia become part of health care, theoretical and practical medicine will be deprived of advances in palliative and supportive therapies. Lack of adequate palliative care is a medical, ethical, psychological, and social problem that needs to be addressed before resorting to such radical methods as legalizing euthanasia.

The Beginning and Ending of Life

2019 ◽  
pp. 162-171
Author(s):  
John Keown
Keyword(s):  
Quality Of Life ◽  
Human Development ◽  
Assisted Suicide ◽  
Human Life ◽  
Terminally Ill ◽  
Medical Law ◽  
Physician Assisted Suicide ◽  
Life Sustaining Treatment ◽  
The Law

This chapter identifies several respects in which medical law in England and Wales suffers from a lack of ethical coherence in relation to its protection of human life. It argues that it is philosophically incoherent for the law to calibrate its protection of human life according to arbitrary stages of human development such as birth, viability, the fourteenth day after fertilization, and implantation. To the extent that the law permits life-sustaining treatment to be withheld or withdrawn from incompetent patients on the ground that their ‘quality of life’ is insufficient, and even with an intent to hasten death, it again displays ethical incoherence. If legislators or judges were to make it lawful for physicians to intentionally assist suicidal refusals of treatment, or to endorse a right to physician-assisted suicide for the ‘terminally ill’, the law's ethical incoherence would be seriously aggravated.

scholarly journals Development and Validation of a Multidisciplinary Mobile Care System for Patients With Advanced Gastrointestinal Cancer: Interventional Observation Study (Preprint)

2017 ◽  
Author(s):  
Ji Yeong Soh ◽  
Won Chul Cha ◽  
Dong Kyung Chang ◽  
Ji Hye Hwang ◽  
Kihyung Kim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Colon Cancer ◽  
Gastrointestinal Cancer ◽  
Response Rate ◽  
Self Monitoring ◽  
Satisfaction Rate ◽  
Cancer Group ◽  
Care System

BACKGROUND Mobile health apps have emerged as supportive tools in the management of advanced cancers. However, only a few apps have self-monitoring features, and they are not standardized and validated. OBJECTIVE This study aimed to develop and validate a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer. METHODS The development of the multidisciplinary mobile health management system was divided into 3 steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. The app was developed to achieve 3 major clinical goals: support for quality of life, nutrition, and rehabilitation. Three main functional themes were developed to achieve clinical goals: a to-do list, health education, and in-app chat. Thirteen clinically oriented measures were included: the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire, Scored Patient-Generated Subjective Global Assessment (PG-SGA), distress, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, International Physical Activity Questionnaire–Short Form, Low anterior resection syndrome score, satisfaction rate, etc. To validate the system, a prospective observational study was conducted. Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited. We followed the subjects for 12 weeks, and selected clinical measures were taken online and offline. RESULTS After the development process, a multidisciplinary app, the Life Manager, was launched. For evaluation, 203 patients were recruited for the study, of whom 101 (49.8%) had gastric cancer, and 102 (50.2%) were receiving palliative care. Most patients were in their fifties (35.5%), and 128 (63.1%) were male. Overall, 176 subjects (86.7%) completed the study. Among subjects who dropped out, the most common reason was the change of patient’s clinical condition (51.9%). During the study period, subjects received multiple health education sessions. For the gastric cancer group, the “general gastric cancer education” was most frequently viewed (322 times), and for the colon cancer group, the “warming-up exercise” was most viewed (340 times). Of 13 measurements taken from subjects, 9 were taken offline (response rate: 52.0% to 90.1%), and 3 were taken online (response rate: 17.6% to 57.4%). The overall satisfaction rate among subjects was favorable and ranged from 3.93 (SD 0.88) to 4.01 (SD 0.87) on the 5-point Likert scale. CONCLUSIONS A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinically oriented measures. A prospective study was performed for its evaluation, which showed favorable satisfaction.

scholarly journals THE PRINCIPLE OF QUALITY OF LIFE VERSUS SANCTITY OF LIFE IN THE EUTHANASIA DEBATE: WHERE DOES ISLAMIC LAW STANDS?

2012 ◽  
Vol 19 (1) ◽  
Author(s):  
Omipidan Bashiru Adeniyi
Keyword(s):  
Quality Of Life ◽  
Terminal Illness ◽  
Assisted Suicide ◽  
Islamic Law ◽  
The Other ◽  
Western World ◽  
Sanctity Of Life ◽  
World Today ◽  
The Right

The trend in most part of the western world today is the agitations for a person to have the right to take his own life, when such life, becomes unbearable due to pain, being the result of a severe or terminal illness. This is the position of proponents of the concept of euthanasia and assisted suicide. Opponents of the concept on the other hand are of the view that no matter the circumstances, a person should not take his own life because he has contributed nothing to its creation. They therefore uphold the sanctity of life as against its quality. This paper seeks to examine the relative arguments and will address the position of Islamic law governing the euthanasia debate.

scholarly journals Comorbidities and Health-Related Quality of Life in Subjects with Spine Osteoarthritis at 50 Years of Age or Older: Data from the Korea National Health and Nutrition Examination Survey

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 126
Author(s):  
Seong-Kyu Kim ◽  
Jung-Yoon Choe
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Lumbar Spine ◽  
Nutrition Examination Survey ◽  
Health Related Quality ◽  
Health And Nutrition ◽  
Related Quality ◽  
Health Related ◽  
Eq Vas

Background and Objective: This study assessed comorbidities and health-related quality of life (HRQOL) in subjects with lumbar spine osteoarthritis (OA) in the Korean population. Materials and Methods: We analyzed 3256 subjects who were 50 years or older and underwent plain radiography of the lumbar spine as part of the Korea National Health and Nutrition Examination Survey (KNHANES) 2012. Radiographic assessment was based on Kellgren–Lawrence (K-L) grade ranging from 0 to 2, with K-L grade 2 defined as lumbar spine OA. HRQOL was assessed by EuroQol-5 dimensions (EQ-5D), which include the EQ-5D index and visual analogue scale (EQ-VAS) measurements. Results: Comorbidities such as hypertension, myocardial infarction, angina, cerebral infarction, and diabetes mellitus were more frequent in spine OA than in controls, while dyslipidemia was less common. Subjects with spine OA had higher mean number of comorbid conditions than controls (1.40 (SE 0.05) vs. 1.20 (SE 0.03), p = 0.001). Subjects with spine OA had much lower EQ-5D index than controls (p < 0.001) but not lower EQ-VAS score. Multivariate binary logistic analysis showed that hypertension and colon cancer were associated with spine OA compared to controls (OR 1.219, 95% CI 1.020–1.456, p = 0.030 and OR 0.200, 95% CI 0.079–0.505, p = 0.001, respectively) after adjustment for confounding factors. Lower EQ-5D index was related to spine OA (95% CI 0.256, 95% CI 0.110–0.595, p = 0.002) but not EQ-VAS score. Conclusion: In this study, we found that comorbidities such as hypertension and colon cancer as well as lower HRQOL were associated with spine OA.

Patients’ Trust in Physician, Patient Enablement, and Health-Related Quality of Life During Colon Cancer Treatment

2017 ◽  
Vol 32 (3) ◽  
pp. 571-579 ◽  
Author(s):  
Nicole Ernstmann ◽  
Markus Wirtz ◽  
Anika Nitzsche ◽  
Sophie E. Gross ◽  
Lena Ansmann ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Cancer Treatment ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Patient Enablement ◽  
Physician Patient

Patient Satisfaction and Health-Related Quality of Life After Treatment for Colon Cancer

2007 ◽  
Vol 50 (6) ◽  
pp. 801-809 ◽  
Author(s):  
Carey A. Gall ◽  
David Weller ◽  
Adrian Esterman ◽  
Louis Pilotto ◽  
Kelly McGorm ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Patient Satisfaction ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Clinical efficacy and safety of early adjuvant chemotherapy for stage III colon cancer: Short-term outcomes of a multicenter, randomized, open-label, phase 3 trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3598-3598
Author(s):  
Jun Seok Park ◽  
Soo Yeun Park ◽  
Gyu-Seog Choi ◽  
Hye Jin Kim ◽  
Jong Gwang Kim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Adverse Events ◽  
Surgical Complication ◽  
Phase Iii ◽  
Stage Iii ◽  
Survival Outcomes ◽  
Stage Iii Colon Cancer

3598 Background: Adjuvant chemotherapy (AC) is recommended to commence within 8 weeks since after surgical resection of stage II or III colon cancer. Results of many retrospective studies showed inferior survival outcomes following delay of AC delay. Moreover, preclinical studies showed that the progression of disseminated cancer cells is profound during the postoperative period. This study is the first prospective trial to evaluate early (≤ 14 days postoperative) AC for patients (pts) with stage III colon cancer. Methods: This study is a prospective, multicenter, randomized phase III trial. Pts with pathological stage III colon cancer were enrolled and randomized 1:1 to early AC (starting AC ≤ 14 days after surgery) or conventional AC (starting AC > 14 days after surgery). Pts were recommended to receive 12 cycles of FOLFOX-6 for AC. The primary endpoint was disease-free survival. The secondary endpoints were overall survival, adverse events, surgical complication during AC, and patient-reported outcomes (quality of life) during 1 year after surgery. Herein, safety data, chemotherapy delivery, and quality of life are presented. Results: This study randomized 443 pts either early AC arm (221pts) or early AC arm (222 pts) to the during September 2011 to March 2020. 380 pts who received at least one cycle of FOLFOX-6 were included in the safety analysis (192 and 188 in the early and conventional AC arms, respectively). The baseline characteristics of the two groups were well-balanced except for the interval from the surgery to the initial AC. The early and conventional AC arms started their first chemotherapy at median of 13 (4-43 days) and 29 (17-53 days) after surgery (p < 0.001), respectively. No significant differences were seen in the median chemotherapy cycles, AC completion, and relative oxaliplatin dose intensity between groups. AC Completion without any change of dose or schedule delay was seen in 18% and 20% in early and conventional AC arms respectively, while dose reduction or delay was 65% and 61%, respectively. Toxicities of grade 3 or more were seen in 28% in both groups. One patient in the early AC arm underwent an emergent operation for anastomotic leakage on the second day of 5-fluorouracil infusion (postoperative day 14). However, the surgical complication was not seen in any other patient. The scores of the European Organization for Research and Treatment of Cancer Quality of Life core 30 questionnaire were similar in both arms at baseline (before starting AC), and 1 month, 3 months, 6 months, and 12 months after surgery. Conclusions: Early AC was safe and did not increase either chemotherapy-related adverse events or surgery-related complications during treatment. Moreover early AC did not reduce the quality of life of the pts during 1 year after surgery. This study continues to follow-up the patients for survival outcomes. Clinical trial information: NCT01460589.

The Impact of Emergency Surgery versus Self-expanding Metallic Stents on Anal Function and Quality of Life in Patients with Complete Obstructing Left-sided Colon Cancer

2021 ◽  
Author(s):  
GanBin Li ◽  
Tao Yu ◽  
Hao-Yu Zhang ◽  
Zhen-Jun Wang ◽  
Guang-Hui Wei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Regression Analysis ◽  
Short Term ◽  
Anal Function ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
Better Than

Abstract Background: Emergence surgery (ES) and self-expanding metallic stents (SEMS) are traditional approaches for complete obstructing left-sided colon cancer. A strategy of “stents-chemotherapy-surgery” was applied in our center recently. Studies assessing the anal function and quality of life of patients with complete obstructing left-sided colon cancer are still lacking.Methods: Patients with complete obstructing left-sided colon cancer were included, and three treatment strategies were used, including ES, SEMS, and SEMS followed by neoadjuvant chemotherapy (NAC) for patients with complete obstructing left-sided colon cancer. The Wexner, Vaizey, and low anterior resection syndrome (LARS) scores were used to assess anal function and the EORTC QLQ C30 score was used to assess quality of life. Logistic regression analysis was used to detect risk factors affecting short-term anal function of patients.RESULTS: The Wexner scores were similar among the groups during the follow-up period. The Vaizey (H=18.415, P=0.001) and LARS scores (H=3.660, P=0.04) both revealed that anal function among patients receiving SEMS and NACwas significantly better than patients who underwent ES at the 1-month post-operative follow-up evaluation; no significant difference existed at the 6- and 12-month follow-up evaluations. The EORTC QLQ C30 score revealed that social function of patients receiving SEMS and NAC was also significantly better than patients undergoing ES (H=7.035, P=0.03). Logistic regression analysis suggested that a one-stage stoma in an emergent setting is an independent risk factor for short-term reduction of anal function among patients with complete obstructing left-sided colon cancer (OR=5.238, 95% CI: 1.569~17.484, P=0.007).Conclusion: Compared to ES, SEMS might be able to improve the quality of life and short-term anal function in patients with complete obstructing left-sided colon cancer.

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