End-of-Life Care: A Philosophical or Management Problem?

2011 ◽  
Vol 39 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Daniel Callahan
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Technological Progress ◽  
Patient Choice ◽  
Living Wills ◽  
Management Problem ◽  
Life Care ◽  
Or Management ◽  
Hospice Movement ◽  
The 1960S

Early in 1970, just as we were organizing The Hastings Center, we had to decide which issues on a long menu of possibilities should receive our early attention. At the top of our list was end-of-life care. Complaints about care for the dying had mounted during the 1960s, fueled by technological progress in sustaining life, by too many patients abandoned by physicians as they lay dying, by a lack of patient choice on how their lives should end, and by woefully inadequate pain management. After a few years of study, the care of the dying seemed to admit of a solution: giving patients more choice by the use of living wills or appointment of a surrogate, improving the training of physicians to better deal with death and discussion with patients, and creating a hospice movement and greatly enhanced palliative care.

scholarly journals Pediatric-Specific End-of-Life Care Quality Measures: An Unmet Need of a Vulnerable Population

2017 ◽  
Vol 13 (10) ◽  
pp. e874-e880 ◽  
Author(s):  
Emily E. Johnston ◽  
Abby R. Rosenberg ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Measures ◽  
Care Quality ◽  
Patient Choice ◽  
Decision Makers ◽  
Hospital Death ◽  
Life Care ◽  
High Quality ◽  
National Quality

We must ensure that the 20,000 US children (age 0 to 19 years) who die as a result of serious illness annually receive high-quality end-of-life care. Ensuring high-quality end-of-life care requires recognition that pediatric end-of-life care is conceptually and operationally different than that for adults. For example, in-hospital adult death is considered an outcome to be avoided, whereas many pediatric families may prefer hospital death. Because pediatric deaths are comparatively rare, not all centers offer pediatric-focused palliative care and hospice services. The unique psychosocial issues facing families who are losing a child include challenges for parent decision makers and young siblings. Furthermore, the focus on advance directive documentation in adult care may be less relevant in pediatrics because parental decision makers are available. Health care quality measures provide a framework for tracking the care provided and aid in agency and provider accountability, reimbursement, and educated patient choice for location of care. The National Quality Forum, Joint Commission, and other groups have developed several end-of-life measures. However, none of the current quality measures focus on the unique needs of dying pediatric patients and their caregivers. To evolve the existing infrastructure to better measure and report quality pediatric end-of-life care, we propose two changes. First, we outline how existing adult quality measures may be modified to better address pediatric end-of-life care. Second, we suggest the formation of a pediatric quality measure end-of-life task force. These are the next steps to evolving end-of-life quality measures to better fit the needs of seriously ill children.

Living wills and end-of-life care of older people in Helsinki: A 10-year follow-up

2013 ◽  
Vol 4 ◽  
pp. S16
Author(s):  
H. Karppinen ◽  
M.L. Laakkonen ◽  
T.E. Strandberg ◽  
S. Tilvis Reijo ◽  
H. Pitkälä Kaisu
Keyword(s):  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Living Wills ◽  
Life Care

scholarly journals End-of-life care and dementia

2005 ◽  
Vol 15 (2) ◽  
pp. 135-148 ◽  
Author(s):  
Louise Robinson ◽  
Julian Hughes ◽  
Sarah Daley ◽  
John Keady ◽  
Clive Ballard ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Current Knowledge ◽  
Patient Choice ◽  
Life Care ◽  
Current Standard ◽  
People With Dementia ◽  
National Service Framework ◽  
The Usa ◽  
The Uk

In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care.

St Christopher's and the Future

2008 ◽  
Vol 56 (1) ◽  
pp. 63-75 ◽  
Author(s):  
Barbara Monroe ◽  
Penny Hansford ◽  
Malcolm Payne ◽  
Nigel Sykes
Keyword(s):  
Health Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Health Care Services ◽  
Care Service ◽  
Health Care Service ◽  
Cost Effective ◽  
Patient Choice ◽  
Life Care ◽  
Effective Models

The founding vision of St Christopher's Hospice was based on a recognition that permeating mainstream health care services would be essential and an emphasis on an adaptable philosophy rather than a building. Today, demographic and disease related changes mean that need and demand for end-of-life care will inevitably outstrip professional and financial resource. Hospices must engage with the development of cost-effective models of service delivery and rational planning. Only partnership working with the National Health Service, care homes, and others will ensure that appropriate care is available to everyone wherever the bed in which they die, regardless of diagnosis. Only collaboration and active engagement will ensure that future strategy in end-of-life care retains the original insight that its focus rightly includes not only patients but also the social context that will be affected by their death. Cost and patient choice dictate an emphasis on care at home. Health-promoting, public education and family-focused strategies will be essential. At a pivotal moment for the delivery of health care generally, hospices can play a vital part by marrying the role of “insistent conscience” of the health care service with continued cost-effective clinical innovation.

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