Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life

2016 ◽  
Vol 34 (1) ◽  
pp. 5-19 ◽  
Author(s):  
Carrie M. Henderson ◽  
Michael FitzGerald ◽  
K. Sarah Hoehn ◽  
Norbert Weidner
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
Palliative Sedation ◽  
Open Communication ◽  
Ethical Concerns ◽  
Level Of Consciousness ◽  
Definition Of ◽  
The Relationship ◽  
Pediatric Providers ◽  
Broad Continuum

Context: Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. Objectives: This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. Methods: Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ2 and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. Results: Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation “completely” reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. Conclusions: Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.

scholarly journals Medicalisation, suffering and control at the end of life: The interplay of deep continuous palliative sedation and assisted dying

2020 ◽  
pp. 136345932097674
Author(s):  
Gitte Hanssen Koksvik ◽  
Naomi Richards ◽  
Sheri Mila Gerson ◽  
Lars Johan Materstvedt ◽  
David Clark
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
Western Europe ◽  
Palliative Sedation ◽  
Good Death ◽  
Assisted Dying ◽  
Qualitative Interview Study ◽  
Continuous Palliative Sedation ◽  
And Control ◽  
The Relationship

Medicalisation is a pervasive feature of contemporary end of life and dying in Western Europe and North America. In this article, we focus on the relationship between two specific aspects of the medicalisation of dying: deep continuous palliative sedation until death and assisted dying. We draw upon a qualitative interview study with 29 health professionals from three jurisdictions where assisted dying is lawful: Flanders, Belgium; Oregon, USA; and Quebec, Canada. Our findings demonstrate that the relationship between palliative sedation and assisted dying is often perceived as fluid and complex. This is inconsistent with current laws as well as with ethical and clinical guidelines according to which the two are categorically distinct. The article contributes to the literature examining health professionals’ opinions and experiences. Moreover, our findings inform a discussion about emergent themes: suffering, timing, autonomy and control – which appear central in the wider discourse in which both palliative sedation and assisted dying are situated, and which in turn relate to the wider ideas about what constitutes a ‘good death’.

scholarly journals Death, ethical judgments and dignity

2018 ◽  
Vol 8 (3-4) ◽  
pp. 201-208 ◽  
Author(s):  
Katarína Komenská
Keyword(s):  
Brain Death ◽  
End Of Life ◽  
Social Consequences ◽  
Ethical Challenges ◽  
Medical Practitioners ◽  
Sanctity Of Life ◽  
Definition Of ◽  
The Relationship ◽  
Defining Death

Abstract In Peter Singer’s article “The Challenge of Brain Death for the Sanctity of Life Ethic”, he articulates that ethics has always played an important role in defining death. He claims that the demand for redefining death spreads rather from new ethical challenges than from a new, scientifically improved understanding of the nature of death. As thorough as his plea for dismissal of the brain-death definition is, he does not avoid the depiction of the complementary relationship between science and ethics. Quite the opposite, he tends to formulate a stronger, philosophically more consistent argument to help science and medical practitioners to define life, death, and the quality of life. In my commentary, I would like to focus on two issues presented in Singer’s study. Firstly, I will critically analyze the relationship between science and ethics. Secondly, I will follow on from Singer’s arguments differentiating between end of life as an organism and end of life as a person. The latter case is necessarily linked with man’s participation in her/his life, setting life goals, and fulfilling her/his idea of good life. Through the consequential definition of the dignity in ethics of social consequences, I will try to support Singer’s idea.

60. Using a pocket card to improve end-of-life care on clinical teaching units: A controlled trials

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
J. Downar ◽  
J. Mikhael
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Palliative Medicine ◽  
Clinical Teaching ◽  
Intervention Group ◽  
Comfort Level ◽  
Control Group ◽  
Life Care ◽  
Comfort Levels

Although palliative and end-of-life is a critical part of in-hospital medical care, residents often have very little formal education in this field. To determine the efficacy of a symptom management pocket card in improving the comfort level and knowledge of residents in delivering end-of-life care on medical clinical teaching units, we performed a controlled trial involving residents on three clinical teaching units. Residents at each site were given a 5-minute questionnaire at the start and at the end of their medicine ward rotation. Measures of self-reported comfort levels were assessed, as were 5 multiple-choice questions reflecting key knowledge areas in end-of-life care. Residents at all three sites were given didactic teaching sessions covering key concepts in palliative and end-of-life care over the course of their medicine ward rotation. Residents at the intervention site were also given a pocket card with information regarding symptom management in end-of-life care. Over 10 months, 137 residents participated on the three clinical teaching units. Comfort levels improved in both control (p < 0.01) and intervention groups (p < 0.01), but the intervention group was significantly more comfortable than the control group at the end of their rotations (z=2.77, p < 0.01). Knowledge was not significantly improved in the control group (p=0.07), but was significantly improved in the intervention group (p < 0.01). The knowledge difference between the two groups approached but did not reach statistical significance at the end of their rotation. In conclusion, our pocket card is a feasible, economical educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on clinical teaching units. Oneschuk D, Moloughney B, Jones-McLean E, Challis A. The Status of Undergraduate Palliative Medicine Education in Canada: a 2001 Survey. Journal Palliative Care 2004; 20:32. Tiernan E, Kearney M, Lynch AM, Holland N, Pyne P. Effectiveness of a teaching programme in pain and symptom management for junior house officers. Support Care Cancer 2001; 9:606-610. Okon TR, Evans JM, Gomez CF, Blackhall LJ. Palliative Educational Outcome with Implementation of PEACE Tool Integrated Clinical Pathway. Journal of Palliative Medicine 2004; 7:279-295.

ADMINISTRATIVE AND LEGAL STATUS OF THE CAPITAL OF UKRAINE - THE HERO CITY OF KYIV AS A GUARANTEE OF THE RIGHTS OF CITIZENS OF UKRAINE AND THE TERRITORIAL COMMUNITY OF THE CITY

2017 ◽  
Author(s):  
Oleksii Chepov ◽  
Keyword(s):  
Legal Status ◽  
Modern World ◽  
Legal Regime ◽  
Legal Doctrine ◽  
City Councils ◽  
The Social ◽  
District Management ◽  
Definition Of ◽  
The Relationship ◽  
The City

The qualitative and clear definition of the legal regime of the capital of Ukraine, the hero city of Kyiv, is influenced by its legislative enshrinement, however, it should be noted that discussions are ongoing and one of the reasons for the unclear legal status of the capital is the ambiguity of current legislation in this area. Separation of the functions of the city of Kyiv, which are carried out to ensure the rights of citizens of Ukraine and the functions that guarantee the rights of the territorial community of the city of Kyiv. In the modern world, in legal doctrine and practice, the capital is understood as the capital of the country, which at the legislative level received this status and, accordingly, is the administrative and political center of the state, which houses the main state bodies and diplomatic missions of other states. It is the identification of the boundaries of the relationship between the competencies of state administrations and local self-government, in practice, often raises questions about their delimitation and ways of regulatory solution. Peculiarities of local self-government in Kyiv city districts are defined in the provisions of the Law on the Capital, which reveal the norms of the Constitution in these legal relations, according to which the issue of organizing district management in cities belongs to city councils. Likewise, it is unregulated by law to lose the particularity of the legal status of the territory of the city. It should be emphasized that the subject of administrative-legal relations is not a certain administrative-territorial entity, but the social group is designated - the territorial community of the city of Kiev, kiyani. Thus, the provisions on the city of Kyiv partially ignore the potential of the territorial community.

Compliance and Conflict of Value in Public Policy Implementation: Comparison between the New Order and the Reformation Era

2018 ◽  
Vol 2 (2) ◽  
pp. 99 ◽  
Author(s):  
Dwiyanto Indiahono ◽  
Erwan Purwanto ◽  
Agus Pramusinto
Keyword(s):  
Public Policy ◽  
Policy Implementation ◽  
Local Level ◽  
Group Discussion ◽  
New Order ◽  
The Reformation ◽  
Public Policy Implementation ◽  
Definition Of ◽  
Conflict Of Value ◽  
The Relationship

This research aims to examine differences in the relationship of bureaucratic and political officials during the New Order (Soeharto’s era) and the Reformation (post-Soeharto) era within the arena of public policy implementation. This is a matter of importance given that there is a change in relations between the two from integration in the New Order to bureaucratic impartiality in the Reformation Era. This study attempts to answer the question: How were the relations of bureaucratic and political officials in the implementation of local level public policy during the New Order and the Reformation Era? A qualitative research has been conducted in Tegal Municipality using the following data collection techniques: interview, focus group discussion, documentation, and observation. Tegal Municipality was selected as the study location because of the unique relationship shown between the mayor and the bureaucracy. Its uniqueness lies in the emergence of bureaucratic officials who dare to oppose political officials, based on their convictions that bureaucratic/public values should be maintained even if it means having to be in direct conflict with political officials. This research indicates that the relationship between bureaucratic and political officials in the arena of local level policy implementation during the New Order was characterized as being full of pressure and compliance, whereas during the Reformation Era bureaucrats have the audacity to hinder policy implementation. Such audacity to thwart policies is considered to have developed from a stance that aims to protect public budget and values in policies. The occurring conflict of values here demonstrates a dichotomy of political and bureaucratic officials that is different from the prevailing definition of politics-administration dichotomy introduced at the onset of Public Administration studies.

The Concept of Europeanization and Possibilities of its Application to the Analysis of Ukraine-EU Relations

2017 ◽  
pp. 149-160
Author(s):  
Natalia Popova
Keyword(s):  
European Integration ◽  
Theoretical Research ◽  
Member States ◽  
External Governance ◽  
Definition Of ◽  
The Relationship ◽  
Eu Studies ◽  
The Eu

The concept of Europeanization has become quite fashionable in EU studies in recent years. It is often used for the analysis of the relations between the EU and non-member states. The aim of the article is to examine the possibilities of its application in explaining the relationship between the EU and Ukraine. The structure of the article is as follows: firstly, the concept of Europeanization is defined considering such two disputable issues as distinguishing among concepts of Europeanization and European integration as well as Europeanization and EU-ization. Next, the evolution of the theoretical research of Europeanization and definition of this concept are analyzed. Two main mechanisms of Europeanization (conditionality and socialization) are examined. The author considers main approaches to the analysis of the "external" Europeanization emphasizing the concept of "external governance". Three groups of factors which influence the effectiveness of Europeanization are briefly analyzed. And finally, the peculiarities of application of the Europeanization concept to the Ukraine-EU relations are outlined. Keywords: EU, Ukraine, Europeanization, EU-ization, ‘external’ Europeanization, conditionality, socialization, concept of ‘external governance’

О вопросах фольклоризма в письменной литературе

2019 ◽  
pp. 31-33
Author(s):  
Суусар Искендерова
Keyword(s):  
Modern Science ◽  
Folk Songs ◽  
Point Of View ◽  
The Past ◽  
Scientific Term ◽  
Literature Culture ◽  
Definition Of ◽  
The Relationship

Аннотация: Исследование проблемы фольклоризма является наиболее актуальной в современной науке о фольклоре. На разных этапах развития художественной литературы для формирования индивидуального творчества писателя особенно значимым становятся фольклорные жанры, сюжетные мотивы и художественные средства. В статье рассматривается связь письменной литературы и фольклора, особенно точка зрения проблеме фольклоризма в прошлом и их анализ. Термин «фольклоризм» начал использоваться советскими исследователями учеными как научный термин еще в 1930-х гг. Термин «фольклоризм» используется в различных сферах культуры, а в этой статье мы будем рассматривать в литературе. Несмотря на то, что на протяжении многих лет этот вопрос изучается литературоведами, фольклористами, все -таки нет единого теоретического определения понятия. Ключевые слова: фольклор, фольклоризм, литература, культура, письменная литература, художественная литература, оседлый народ, пословицы и поговорки, фольклорные песни. Аннотация: Көркөм адабияттын өнүгүүсүнүн ар кайсы баскычтарында сүрөткердин жеке чыгармачылыгынын калыптанышы үчүн фольклордук жанрлар, сюжеттер, мотивдер жана көркөм каражаттар айрыкча мааниге ээ. Макалада жазма адабият менен фольклордук карым-катышы, айрыкча фольклоризм маселеси жөнүндө мурдагы көз караштарга кайрылып, аларга талдоо жүргүзүү менен бирге автор өз байкоолорунда келтирет. “Фольклоризм” деген илимий термин 1930-жылы баштап колдонула баштаган. “Фольклоризм” термини маданияттын түрдүү сфераларында кеңири колдо- нулат, бул жерде адабияттагы колдонулушун каралат. Макалада адабий материал менен фольклордук байланышын терең түшүнүү үчүн адабий фольклоризм маселесинин талаштуу жактары каралат. Түйүндүү сөздөр: фольклор, фольклоризм, адабият, маданият, жазма адабият, көркөм адабият, көчмөн калк, макал-лакап, фольклордук ырлар. Annotation: The study of the problem of folklore is the most relevant in the modern science of folklore. At various stages in the development of fiction, folklore genres, plot motifs, and artistic means become especially significant for the formation of the writer's individual creativity. The article examines the relationship between written literature and folklore, especially the point of view of the problem of folklorism in the past and their analysis. The term "folklorism" began to be used by Soviet scholars as a scientific term back in the 1930s. The term "folklorism" is used in various fields of culture, and in this article we will consider in the literature. Despite the fact that for many years this issue has been studied by literary scholars, folklorists, all the same there is no single theoretical definition of the concept. Keywords: folklore, folklorism, literature, culture, written literature, fiction, settled people, proverbs and sayings, folk songs.

Sifat-sifat Submodul Prima dan Submodul Prima Lemah

2020 ◽  
Vol 2 (2) ◽  
pp. 183
Author(s):  
Hisyam Ihsan ◽  
Muhammad Abdy ◽  
Samsu Alam B
Keyword(s):  
Prime Ideal ◽  
Literature Study ◽  
Prime Submodules ◽  
Unitary Module ◽  
Prime Submodule ◽  
Definition Of ◽  
The Relationship

Penelitian ini merupakan penelitian kajian pustaka yang bertujuan untuk mengkaji sifat-sifat submodul prima dan submodul prima lemah serta hubungan antara keduanya. Kajian dimulai dari definisi submodul prima dan submodul prima lemah, selanjutnya dikaji mengenai sifat-sifat dari keduanya. Pada penelitian ini, semua ring yang diberikan adalah ring komutatif dengan unsur kesatuan dan modul yang diberikan adalah modul uniter. Sebagai hasil dari penelitian ini diperoleh beberapa pernyataan yang ekuivalen, misalkan  suatu -modul ,  submodul sejati di  dan ideal di , maka ketiga pernyataan berikut ekuivalen, (1)  merupakan submodul prima, (2) Setiap submodul tak nol dari   -modul memiliki annihilator yang sama, (3) Untuk setiap submodul  di , subring  di , jika berlaku  maka  atau . Di lain hal, pada submodul prima lemah jika diberikan  suatu -modul,  submodul sejati di , maka pernyataan berikut ekuivalen, yaitu (1) Submodul  merupakan submodul prima lemah, (2) Untuk setiap , jika  maka . Selain itu, didapatkan pula hubungan antara keduanya, yaitu setiap submodul prima merupakan submodul prima lemah.Kata Kunci: Submodul Prima, Submodul Prima Lemah, Ideal Prima. This research is literature study that aims to examine the properties of prime submodules and weakly prime submodules and the relationship between  both of them. The study starts from the definition of prime submodules and weakly prime submodules, then reviewed about the properties both of them. Throughout this paper all rings are commutative with identity and all modules are unitary. As the result of this research, obtained several equivalent statements, let  be a -module,  be a proper submodule of  and  ideal of , then the following three statetments are equivalent, (1)  is a prime submodule, (2) Every nonzero submodule of   -module has the same annihilator, (3) For any submodule  of , subring  of , if  then  or . In other case, for weakly prime submodules, if given  is a unitary -module,  be a proper submodule of , then the following statements are equivalent, (1)  is a weakly prime submodule, (2) For any , if  then . In addition, also found the relationship between both of them, i.e. any prime submodule is weakly prime submodule.Keywords: Prime Submodules, Weakly Prime Submdules, Prime Ideal.

Two Theories of Effective Government

2017 ◽  
Author(s):  
Johannes Lindvall
Keyword(s):  
Political Science ◽  
Political Institutions ◽  
Public Policies ◽  
Methodological Approach ◽  
Decision Makers ◽  
Precise Definition ◽  
Policy Changes ◽  
Political Decision ◽  
Definition Of ◽  
The Relationship

This chapter introduces the problem of “reform capacity” (the ability of political decision-makers to adopt and implement policy changes that benefit society as a whole, by adjusting public policies to changing economic, social, and political circumstances). The chapter also reviews the long-standing discussion in political science about the relationship between political institutions and effective government. Furthermore, the chapter explains why the possibility of compensation matters greatly for the politics of reform; provides a precise definition of the concept of reform capacity; describes the book's general approach to this problem; and discusses the ethics of compensating losers from reform; and presents the book's methodological approach.

Physicianship and the Rebirth of Medical Education

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric Cassell ◽  
Abraham Fuks
Keyword(s):  
Medical Education ◽  
Educational Process ◽  
Medical Attention ◽  
Patient Centeredness ◽  
Goals Of Medicine ◽  
The Subject ◽  
Definition Of ◽  
And Function ◽  
William Osler ◽  
The Relationship

This book reimagines medical education and reconstructs its design. It originates from a reappraisal of the goals of medicine and the nature of the relationship between doctor and patient. The educational blueprint outlined is called the “Physicianship Curriculum” and rests on two linchpins. First is a new definition of sickness: Patients know themselves to be ill when they cannot pursue their purposes and goals in life because of impairments in functioning. This perspective represents a bulwark against medical attention shifting from patients to diseases. The curriculum teaches about patients as functional persons, from their anatomy to their social selves, starting in the first days of the educational program and continuing throughout. Their teaching also rests on the rock-solid grounding of medicine in the sciences and scientific understandings of disease and function. The illness definition and knowledge base together create a foundation for authentic patient-centeredness. Second, the training of physicians depends on and culminates in development of a unique professional identity. This is grounded in the historical evolution of the profession, reaching back to Hippocrates. It leads to reformulation of the educational process as clinical apprenticeships and moral mentorships. “Rebirth” in the title suggests that critical ingredients of medical education have previously been articulated. The book argues that the apprenticeship model, as experienced, enriched, taught, and exemplified by William Osler, constitutes a time-honored foundation. Osler’s “natural method of teaching the subject of medicine” is a precursor to the Physicianship Curriculum.

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