Controlled Donation After Circulatory Determination of Death

2016 ◽  
Vol 32 (3) ◽  
pp. 179-186 ◽  
Author(s):  
Anne L. Dalle Ave ◽  
David M. Shaw
Keyword(s):  
Informed Consent ◽  
End Of Life ◽  
Conflict Of Interest ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Life Care ◽  
Determination Of Death ◽  
The Family

Controlled donation after circulatory determination of death (cDCDD) concerns donation after withdrawal of life-sustaining therapy (W-LST). We examine the ethical issues raised by W-LST in the cDCDD context in the light of a review of cDCDD protocols and the ethical literature. Our analysis confirms that W-LST procedures vary considerably among cDCDD centers and that despite existing recommendations, the conflict of interest in the W-LST decision and process might be difficult to avoid, the process of W-LST might interfere with usual end-of-life care, and there is a risk of hastening death. In order to ensure that the practice of W-LST meets already well-established ethical recommendations, we suggest that W-LST should be managed in the ICU by an ICU physician who has been part of the W-LST decision. Recommending extubation for W-LST, when this is not necessarily the preferred procedure, is inconsistent with the recommendation to follow usual W-LST protocol. As the risk of conflicts of interest in the decision of W-LST and in the process of W-LST exists, this should be acknowledged and disclosed. Finally, when cDCDD programs interfere with W-LST and end-of-life care, this should be transparently disclosed to the family, and specific informed consent is necessary.

Conflicts of interest, end-of-life care and organ donation

2020 ◽  
Author(s):  
Cameron Stewart ◽  
Wendy Lipworth ◽  
Paul Komesaroff ◽  
Ian Kerridge
Keyword(s):  
Organ Donation ◽  
End Of Life ◽  
End Of Life Care ◽  
Conflicts Of Interest ◽  
Life Care

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

2018 ◽  
Vol 45 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Lori Seller ◽  
Marie-Ève Bouthillier ◽  
Veronique Fraser
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Retrospective Chart Review ◽  
Median Number ◽  
Life Care ◽  
Ethical Considerations ◽  
Term Care ◽  
Medical Aid ◽  
Aid In Dying

BackgroundMedical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

Ethical issues in palliative and end-of-life care

2018 ◽  
pp. 91-118
Author(s):  
Anne Halli-Tierney ◽  
Amy Albright ◽  
Deanna Dragan ◽  
Megan Lippe ◽  
Rebecca S. Allen
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Life Care

Palliative and end-of-life care in Egypt: overview and recommendations for improvement

2020 ◽  
Vol 26 (6) ◽  
pp. 284-291 ◽  
Author(s):  
Sameh Eltaybani ◽  
Ayumi Igarashi ◽  
Noriko Yamamoto-Mitani
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Cultural Context ◽  
Ethical Issues ◽  
Clear Picture ◽  
Life Care ◽  
Health And Illness ◽  
Care Situation ◽  
Country Specific ◽  
Made In

Background: The literature on the situation of palliative and end-of-life care in the Arab and Islamic world, including Egypt, is limited and does not present a clear picture of the cultural context. This report aims to portray the palliative and end-of-life care situation in Egypt, focusing on the nursing viewpoint. First, we describe health- and illness-related cultural, religious, and ethical issues. Second, we present an overview of the healthcare and nursing system in Egypt. Third, we discuss the situation of palliative and end-of-life care, highlighting the shortcomings of existing literature. Finally, we delineate country-specific recommendations to improve the palliative and end-of-life care situation at the level of policy, education, and research. Countries with similar healthcare, cultural, legal, religious, economic, or ethical contexts may benefit from the recommendations made in this study.

scholarly journals The bioethics of end-of-life care in Internal Medicine: decision making and setting of care

2013 ◽  
pp. 133-138
Author(s):  
Giancarlo Traisci
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Present Report ◽  
Clinical Care ◽  
Terminal Phase ◽  
Life Care ◽  
Physician Patient Relationship

Introduction In the field of Internal Medicine, the management of the terminal phase of an illness raises important issues involving clinical care, with particular reference to the physician-patient relationship. The present report describes the professional code of conduct relative to the assessments and decision making involved in end-of-life care. Materials and methods The article summarizes and discusses Italian common deontological low and the current positions of national and international experts in the field of end-of-life care. Results The ethical issues regarding euthanasia, withdrawal/withholding of health care, and medical treatment that uselessly prolongs the life of a terminal patient are defined and analyzed in conjunction with the outcomes suggested by the palliative medicine. Discussion Physicians caring for patients at the end of their lives must give consideration to bioethical approach.

scholarly journals Co-construction of the family-focused support conversation: a participatory learning and action research study to implement support for family members whose relatives are being discharged for end-of-life care at home or in a nursing home

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sue Duke ◽  
◽  
Natasha Campling ◽  
Carl R. May ◽  
Susi Lund ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Research Evidence ◽  
Care Transitions ◽  
Family Members ◽  
Life Care ◽  
The Family ◽  
Acute Hospitals ◽  
Pilot Implementation ◽  
Context Specific

Abstract Background Many people move in and out of hospital in the last few weeks of life. These care transitions can be distressing for family members because they signify the deterioration and impending death of their ill relative and forthcoming family bereavement. Whilst there is evidence about psychosocial support for family members providing end-of-life care at home, there is limited evidence about how this can be provided in acute hospitals during care transitions. Consequently, family members report a lack of support from hospital-based healthcare professionals. Methods The aim of the study was to implement research evidence for family support at the end-of-life in acute hospital care. Informed by Participatory Learning and Action Research and Normalization Process Theory (NPT) we co-designed a context-specific intervention, the Family-Focused Support Conversation, from a detailed review of research evidence. We undertook a pilot implementation in three acute hospital Trusts in England to assess the potential for the intervention to be used in clinical practice. Pilot implementation was undertaken during a three-month period by seven clinical co-researchers - nurses and occupational therapists in hospital specialist palliative care services. Implementation was evaluated through data comprised of reflective records of intervention delivery (n = 22), in-depth records of telephone implementation support meetings between research team members and co-researchers (n = 3), and in-depth evaluation meetings (n = 2). Data were qualitatively analysed using an NPT framework designed for intervention evaluation. Results Clinical co-researchers readily incorporated the Family-Focused Support Conversation into their everyday work. The intervention changed family support from being solely patient-focused, providing information about patient needs, to family-focused, identifying family concerns about the significance and implications of discharge and facilitating family-focused care. Co-researchers reported an increase in family members’ involvement in discharge decisions and end-of-life care planning. Conclusion The Family-Focused Support Conversation is a novel, evidenced-based and context specific intervention. Pilot implementation demonstrated the potential for the intervention to be used in acute hospitals to support family members during end-of-life care transitions. This subsequently informed a larger scale implementation study. Trial registration n/a.

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