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’.

Common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying

2019 ◽  
Vol 33 (6) ◽  
pp. 562-569 ◽  
Author(s):  
Sarah-May Blaschke ◽  
Penelope Schofield ◽  
Keryn Taylor ◽  
Anna Ugalde
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Policy Development ◽  
Sampling Strategy ◽  
Assisted Dying ◽  
Life Care ◽  
Structured Interviews ◽  
Moral Philosophies

Background: Debate about appropriate and ethically acceptable end-of-life choices is ongoing, which includes discussion about the legalization of voluntary assisted dying. Given health professionals’ role in caring for patients at the end life, their stance towards assisting a person with dying can have implications for policy development and implementation in jurisdictions where law changes are being considered. Aim: To explore end-of-life care professionals’ attitudes towards voluntary assisted dying 6 months prior to vote on legalization. Design: Qualitative study using textual data collected through semi-structured interviews. Purposive sampling strategy used to collect a broad representation of perspectives. Audio-recorded interviews were transcribed verbatim and subjected to qualitative descriptive analysis techniques. Participants: A total of 16 health professionals with experience in caring for people with life-limiting illness. Results: Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of voluntary assisted dying. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing voluntary assisted dying. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high-quality care equitable and widely available. Conclusion: Common dedication to reducing suffering and facilitating good dying experiences exists among experts despite their divergent views on voluntary assisted dying. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for best patient care.

The privilege of a good death: An intersectional perspective on dying a good death in America

2021 ◽  
Author(s):  
Miranda Corpora
Keyword(s):  
Conceptual Framework ◽  
End Of Life ◽  
End Of Life Care ◽  
Social Identities ◽  
Case Vignette ◽  
Good Death ◽  
Diverse Population ◽  
Life Care ◽  
Intersectionality Theory ◽  
The Relationship

Abstract All individuals deserve an equitable opportunity to achieve a good death. Unfortunately, access to end-of-life care and services is largely unequal on the basis of race, gender, class, and other social identities. We need to understand how individuals with multiple marginalized identities face different access in attaining a good death and use this knowledge to bring equity to end-of- life care. The conceptual framework for this argument derives from intersectionality theory and the existing disparities in end-of-life care. This argument sheds light on the relationship between intersectionality and a good death, demonstrated by a case vignette, and suggests that the more marginalized social identities one has, the more difficult their access to a good death. Because it is particularly important to both recognize and actively combat these inequities, I offer three practical strategies for end-of-life researchers and practitioners. For the sake of our increasingly diverse population, advancements in end-of-life care must be made to facilitate a good death for all.

scholarly journals Controlo Sintomático nos Doentes em Fim de Vida

2017 ◽  
Vol 30 (1) ◽  
pp. 61
Author(s):  
Mariana Alves ◽  
Rita Abril ◽  
Isabel Galriça Neto
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Health Professionals ◽  
Basic Skills ◽  
Palliative Sedation ◽  
Refractory Symptoms ◽  
Medical Careers ◽  
Symptomatic Management ◽  
Basic Concepts

End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

scholarly journals “I haven’t had to bare my soul but now I kind of have to”: describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria, Australia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Casey Michelle Haining ◽  
Louise Anne Keogh
Keyword(s):  
Health Professional ◽  
End Of Life ◽  
Health Professionals ◽  
Medical Service ◽  
Qualitative Interviews ◽  
Conscientious Objection ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Conscientious Objectors ◽  
Education Needs

Abstract Background Dealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process. Methods Seventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically. Results Our results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants. Conclusion The broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately.

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.

From Container to Claustrum: Projective Identification in Couples

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Tamara Feldman
Keyword(s):  
Psychological Health ◽  
Projective Identification ◽  
The Self ◽  
The Other ◽  
Intimate Partners ◽  
And Control ◽  
The Relationship ◽  
As If

This paper is a contribution to the growing literature on the role of projective identification in understanding couples' dynamics. Projective identification as a defence is well suited to couples, as intimate partners provide an ideal location to deposit unwanted parts of the self. This paper illustrates how projective identification functions differently depending on the psychological health of the couple. It elucidates how healthier couples use projective identification more as a form of communication, whereas disturbed couples are inclined to employ it to invade and control the other, as captured by Meltzer's concept of "intrusive identification". These different uses of projective identification affect couples' capacities to provide what Bion called "containment". In disturbed couples, partners serve as what Meltzer termed "claustrums" whereby projections are not contained, but imprisoned or entombed in the other. Applying the concept of claustrum helps illuminate common feelings these couples express, such as feeling suffocated, stifled, trapped, held hostage, or feeling as if the relationship is killing them. Finally, this paper presents treatment challenges in working with more disturbed couples.

Content Analysis (Analisis Isi) terhadap Peraturan Daerah Bernuansa Syariat Islam di Kabupaten Banyumas

2019 ◽  
Vol 1 (2) ◽  
pp. 121
Author(s):  
Dody Nur Andriyan
Keyword(s):  
Disease Management ◽  
Public Interest ◽  
Islamic Law ◽  
Alcoholic Beverages ◽  
Public Issues ◽  
Criminal Sanctions ◽  
Qualitative Descriptive ◽  
Administrative Sanctions ◽  
And Control ◽  
The Relationship

Regional Regulation (Perda) which regulates public issues such as prostitution, alcoholic beverages, gambling, and the relationship between men and women turns out to be identified as a Regional Regulation with nuances of Islamic law. in Banyumas Regency there is a Regional Regulation which if used by the identification of Arfiansyah above, it can be referred to as a Regional Regulation with nuances of Islamic law. The regulation is: Banyumas District Regulation Number 15 of 2014 concerning Control, Supervision and Control of Circulation of Alcoholic Beverages and Regional Regulations of Banyumas Regency Number 16 of 2015 concerning Community Disease Management. This research has two formulations of the first problem related to the results of the content of the analysis on the Perda that are nuanced by Islamic law in Banyumas Regency. Both of the results of the analysis content on the Regional Regulations that are nuanced by Islamic law in Banyumas Regency are not contrary to Law-Invitation Number 12 of 2011? This research is a qualitative-descriptive study. The research method used is normative juridical. The main source of data is the Banyumas District Regulation Number 15 of 2014 concerning Control, Supervision and Control of Circulation of Alcoholic Beverages and Regional Regulations of Banyumas Regency Number 16 of 2015 concerning Community Disease Management. Interviews were also conducted with resource persons. Furthermore, the results of the analysis were carried out. Regional Regulation No. 15 of 2014 is actually a Regional Regulation that has a broad purpose of public interest, for the nation and state. So that the claim that Perda No 15 of 2014 as a Regional Regulation with nuances of Islamic law is not true. Regional Regulation No. 16 of 2015 is actually a Regional Regulation that has a broad purpose of public interest, for the nation and state. So that the claim that Perda No 16 of 2015 as a Regional Regulation with nuances of Islamic law is not true. Both of these Perda (Perda No 15 of 2014 and Perda No. 16 of 2015) are not in conflict with Law No. 12 of 2011 concerning the Establishment of Legislation. Both in terms of content, principles, goals, arrangements, administrative sanctions and criminal sanctions. Formally and procedurally the two Perda are in accordance with Law Number 12 of 2011

Oral health diseases among the older people: a general health perspective

2020 ◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Oral Health ◽  
Older People ◽  
Health Professionals ◽  
General Health ◽  
Oral Health Care ◽  
Oral Diseases ◽  
Public Health Professionals ◽  
The Relationship

Background: The relationship between oral health and general health is gaining interest in geriatric research; however, a lack of studies dealing with this issue from a general perspective makes it somewhat inaccessible to non-clinical public health professionals. Purpose: The purpose of this review is to describe the relationship between oral health and general health of the elderly on the basis of literature review, and to give non-clinical medical professionals and public health professionals an overview of this discipline. Methods: This study was based on an in-depth review of the literature pertaining to the relationship between oral health and general health among the older people. The tools commonly used to evaluate dental health and the academic researches of male elderly people were also reviewed. And future research directions were summarized. Results: Dental caries, periodontal disease, edentulism, and xerostomia are common oral diseases among the older people. Dental caries and periodontal diseases are the leading causes of missing teeth and edentulism. Xerostomia, similar to dry mouth, is another common oral health disease in the older people. No clear correlation exists between the subjective feeling of dryness and an objective decrease of saliva. Rather, both conditions can be explained by changes in saliva. The General Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile (OHIP) are the main assessment tools used to examine oral health and quality of life in the older people. The GOHAI tends to be more sensitive to objective values pertaining to oral function. In addition, oral health studies in male elderly people are population-based cohort or cross-sectional studies, involving masticatory function, oral prevention, frailty problems, cardiovascular disease risk, and cognitive status. Conclusion: It is possible to reduce the incidence of certain oral diseases, even among individuals who take oral health care seriously. Oral health care should be based on the viewpoint of comprehensive treatment, including adequate nutrition, good life and psychology, and correct oral health care methods. In the future, researchers could combine the results of meta-analysis with the clinical experience of doctors to provide a more in-depth and broader discussion on oral health research topics concerning the older people.

The effect of type of water supply on water quality in a developing community in South Africa

1997 ◽  
Vol 35 (11-12) ◽  
pp. 35-40 ◽  
Author(s):  
B. Genthe ◽  
N. Strauss ◽  
J. Seager ◽  
C. Vundule ◽  
F. Maforah ◽  
...  
Keyword(s):  
Water Quality ◽  
Water Supply ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
E Coli ◽  
Guideline Values ◽  
Developing Communities ◽  
Quality Guideline ◽  
And Control ◽  
The Relationship

Efforts to provide water to developing communities in South Africa have resulted in various types of water supplies being used. This study examined the relationship between the type of water supply and the quality of water used. Source (communal taps, private outdoor and indoor taps) and point-of-use water samples were examined for heterotrophic plate counts (HPC), total and faecal coliforms, E. coli, and coliphages. Ten percent of samples were also analysed for enteric viruses, Giardia and Cryptosporidium. Approximately 320 households were included in a case-control study. In addition, a cross-sectional study was conducted. Both studies examined the relationship between different types of water facilities and diarrhoea among pre-school children. The source water was of good microbial quality, but water quality was found to have deteriorated significantly after handling and storage in both case and control households, exceeding drinking water quality guideline values by 1-6 orders of magnitude. Coliphage counts were low for all water samples tested. Enteric viruses and Cryptosporidium oocysts were not detected. Giardia cysts were detected on one occasion in case and control in-house samples. Comparisons of whether in-house water, after handling and storage, complied with water quality guideline values demonstrated households using communal taps to have significantly poorer quality than households using private outdoor or indoor taps for HPC and E. coli (χ2 = 14.9, P = 0.001; χ2 = 6.6, P = 0.04 respectively). A similar trend (although not statistically significant) was observed for the other microbial indicators. The cross-sectional study demonstrated an apparent decrease in health risk associated with private outdoor taps in comparison to communal taps. This study suggests that a private outdoor tap is the minimum level of water supply in order to ensure the supply of safe water to developing communities.

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