scholarly journals 中國第一起嗎啡勝訴案的背後——臨終關懷病人使用嗎啡的儒家倫理問題

2018 ◽  
Vol 16 (1) ◽  
pp. 75-95
Author(s):  
Sihan SUN
Keyword(s):  
Palliative Care ◽  
Filial Piety ◽  
Chinese Culture ◽  
Illicit Drugs ◽  
Close Association ◽  
World Health ◽  
Confucian Ethics ◽  
Terminal Phase ◽  
Clinical Settings ◽  
Health Organization

LANGUAGE NOTE | Document text in Chinese; abstract also in English.緩解癌痛是終末期癌症患者安寧療護的重要目標之一。世界衛生組織提出，嗎啡等鴉片類藥物被列為癌症止痛和安寧療護的首選或必備藥物。而談起嗎啡時，人們常常聯想到毒品。尤其在中國這樣一個深受兩次鴉片戰爭影響的國家，人們畏懼嗎啡，並更加謹慎地使用嗎啡。在臨床上，嗎啡的確能夠有效地緩解患者臨終前因癌症引起的疼痛，但不合理地使用也會引起患者的呼吸抑制，導致其死亡。那麼，臨床上到底應該如何正確地使用嗎啡？嗎啡的使用有哪些制度上的支援？嗎啡被當作主動安樂死的一種手段又是否能夠得到儒家倫理學上的辯護？筆者認為，無論在臨床中，還是在制定嗎啡的相關法律法規中，都應將嗎啡的兩種作用：合理劑量的鎮痛作用和加大劑量的主動安樂死作用嚴格的區分開來。用嗎啡安樂死的行為違背了儒家的孝道、弘毅美德以及儒家生命觀和仁愛的思想。本文將通過探究嗎啡的歷史、臨床使用、政策和儒家倫理四個方面，對嗎啡的使用進行具體的研究和分析。Pain control is one of the most important goals of end-of-life care for cancer patients in the terminal phase. The World Health Organization recommends that morphine be considered optimal and even indispensable as a means of relieving pain and providing palliative care. However, people often associate this opioid with illicit drugs, particularly in the context of Chinese culture, due to its close association with the two Anglo–Chinese Opium Wars of the mid-19th century. In clinical settings, morphine is usually the preferred treatment for moderate or severe cancer-related pain. However, excessive morphine use may result in respiratory depression and death. Exploring morphine’s history and clinical usage, relevant policies, and Confucian ethics, this essay shows that a clear distinction must be made between relieving pain and performing active euthanasia in cases of morphine use in current Chinese palliative care and bioethics. The essay offers an approach based on Confucian ethics to analyze how euthanasia via morphine use violates the principles of filial piety (xiao) and humaneness (ren), two virtues emphasized in Confucian tradition.DOWNLOAD HISTORY | This article has been downloaded 432 times in Digital Commons before migrating into this platform.

scholarly journals Last Chance to Care: An Autoethnography of End-of-Life Care in Indonesia

2018 ◽  
Author(s):  
Petra Wessner
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Health Care Service ◽  
World Health ◽  
Life Care ◽  
Possible World ◽  
Palliative Care Services ◽  
Health Organization

In Australia, palliative care is an accepted and expected part of contemporary health care service provision. Efficacious palliative care focusses on managing pain and symptoms and making the patient as comfortable as possible (World Health Organization Definition of Palliative Care (WHO, 2010). As well, palliative care focusses on the spiritual and psycho-social dimensions of life (Martina, 2017), providing the opportunity for the patient and their family to continue to be engaged with life and self-determined decision making throughout palliation. In this account, utilizing the qualitative research method of autoethnography the Australian author describes her experience of caring for her Indonesian father-in-law in the last week of his life. She explores emerging tensions associated with local end-of-life care and Western care which trigger deeper feelings associated with losing a loved one, complicated by the recent and sudden loss of her own parents. Narration is a powerful tool for capturing the verisimilitude of everyday experiences, evoking in the reader a powerful resonance into a very personal inner life which is often not spoken about in academic texts. This account, a cultural story of dying in East Java, Indonesia, also provides insight into the author’s expectations, as an Australian and concludes with some reflections about the emerging position of palliative care services in Indonesia.

scholarly journals PENGEMBANGAN KAPASITAS PEREMPUAN BAGI IBU-IBU RELAWAN PROGRAM PALIATIF DI DESA KAMBINGAN DAN DESA KREMBUNG, KECAMATAN CERME, KABUPATEN GRESIK

2020 ◽  
Vol 4 (1) ◽  
pp. 189
Author(s):  
Sulikah Asmorowati ◽  
Inge Dhamanty
Keyword(s):  
Palliative Care ◽  
High Rate ◽  
World Health ◽  
Target Area ◽  
Target Groups ◽  
Community Project ◽  
Health Organization ◽  
End Stage

The high rate of deaths caused by serious illnesses has led the World Health Organization (WHO) to recommend palliative care that is considered to be able to improve the quality of patient’s live Palliative care or service is service for patients with serious illnesses, such as cancer (stadium or end-stage). In this activity, however, palliative care and service is extended so that it includes diseases that are not contagious but deadly (thus, contributed significantly to mortality rate), including such illnesses as diabetes, high-blood pressure, cholesterol, stroke and other similar illnesses. These illnesses are now increasingly being suffered by and become the major cause of death (caused by illnesses) amongst Indonesians. In order to increase the availability of palliative services in the target area, this community project provides training and assistance to develop women’s capacity in the villages of Kambingan and Ngembung, Cerme, Gresik, so that they are ready to volunteers for palliative care and service in their respective communities. The projects were conducted by providing material through lectures, and modules; followed by assistance to form a team of palliative case and service. At the end, this project resulted in the increasing understanding, and capacity of women (and mothers or PKK member), as the target groups about palliative care and services. In turn, the women were then ready to become volunteers for palliative care and program.abstrakTingginya tingkat kematian akibat penyakit serius membuat WHO menyarankan untuk melakukan perawatan paliatif yang dianggap dapat meningkatkan kualitas hidup pasien. Program atau layanan paliatif adalah pelayanan kepada pasien dengan penyakit berat, yaitu kanker (stadium akhir). Dalam kegiatan pengabdian masyarakat (pengmas) ini, layanan paliatif diperluas sehingga meliputi pula penyakit-penyakit yang tidak menular namun mematikan, seperti penyakit diabates, darah tinggi, kolesterol, stroke dan sejenisnya yang dewasa ini semakin banyak di derita masyarakat Indonesia. Kegiatan pengmas ini memberikan pelatihan dan pendampingan untuk mengembangkan kapasitas ibu-ibu tim penggerak dan anggota PKK di Desa Kambingan dan Desa Ngembung, Kecamatan Cerme, Kabupaten Gresik agar siap untuk menjadi relawan program paliatif di lingkungan masyarakat masing-masing. Metode yang digunakan dalam kegiatan ini adalah dengan pemberian materi melalui ceramah, pemberian modul, serta pendampingan pembentukan tim paliatif sebagai follow-up kegiatan. Hasil yang dicapai dari kegiatan pengabdian masyarakat ini adalah meningkatnya pemahaman masyarakat khususnya ibu-ibu tentang layanan paliatif, serta meningkatnya kapasitas mereka,sehingga siap menjadi relawan program paliatif.

scholarly journals Inclusion of palliative care teaching in medical schools in Brazil

2021 ◽  
Vol 45 (2) ◽  
Author(s):  
Andrea Augusta Castro ◽  
Stella Regina Taquette ◽  
Natan Iório Marques
Keyword(s):  
Palliative Care ◽  
Medical Training ◽  
National Curriculum ◽  
Medical Schools ◽  
World Health ◽  
Ministry Of Education ◽  
The North ◽  
Curriculum Guidelines ◽  
Legal Frameworks ◽  
Health Organization

Abstract: Introduction: The palliative care (PC) approach is a care modality recommended by the World Health Organization. Suffering and the process of dying are present in everyday clinical practice, affecting people with life-threatening diseases. However, the predominant model of teaching in Brazilian medical schools does not include palliative care. Objectives: The aim of the study was to get to know the Brazilian medical schools that include PC in their curriculum, and how it has been taught. Methods: Descriptive and exploratory study, carried out by searching for medical schools with disciplines in PC, through the analysis of the course syllabi available in the curricular matrices on the official websites of higher education institutions from August to December 2018. They were analyzed considering the offered period of the PC content, workload, scenario, and type of discipline (elective or mandatory). Results: 315 schools registered with the Ministry of Education were found, and only 44 of them (14%) offer courses in PC. These schools are distributed throughout 11 Brazilian states, of which 52% are located in the Southeast region, 25% in the Northeast, 18% in the South, 5% in the Midwest, and none in the North region. The predominant modality of the type of discipline in PC was mandatory in 61% of schools. Most Brazilian medical schools are private entities (57%), a similar percentage to the total number of medical schools identified with the teaching of PC. This course takes place in the 3rd and 4th years of the course; in most schools, the workload was 46,9 hours. The predominant scenario is the classroom, while some institutions provide integration between teaching community service and medical practice. The program contents are diverse, including thanatology, geriatrics and finitude, humanization, bioethics, pain, oncology and chronic diseases. Conclusion: PC education in Brazil is insufficient, which represents a barrier to the training of doctors in line with the recommendations of international entities, the National Curriculum Guidelines and legal frameworks within the scope of SUS. Investments by medical entities and government agencies are necessary to increase teaching in PC and the consequent qualification of medical training.

Overview of symptoms and their assessment in life-limiting illness

2021 ◽  
pp. 137-144
Author(s):  
Dilini Rajapakse ◽  
Maggie Comac
Keyword(s):  
Palliative Care ◽  
Future Study ◽  
Symptom Assessment ◽  
World Health ◽  
Guidance Document ◽  
Paediatric Palliative Care ◽  
The World ◽  
Novel Approaches ◽  
Moral Necessity ◽  
Health Organization

The aims of this chapter are to discuss the prevalence of symptoms in paediatric palliative care, the importance of accurate symptom assessment, as well as the principles of and challenges to assessing symptoms comprehensively. We examine the areas where knowledge and expertise are lacking and the reasons for this. Finally, we discuss novel approaches to assessing symptoms and discuss areas for future study. In 2018 the World Health Organization published a guidance document for healthcare workers delivering paediatric palliative care in which it describes ‘the medical and moral necessity of making palliative care accessible to all children in need and their families’.

Pain: introduction

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Palliative Care ◽  
World Health Organization ◽  
Pharmacological Treatment ◽  
Cultural Influences ◽  
Pain Severity ◽  
World Health ◽  
Assessment And Evaluation ◽  
Total Pain ◽  
The World ◽  
Health Organization

Pain is a subjective and multidimensional phenomenon. Diagnosis, assessment, and evaluation of pain are all complicated in children by the range of diagnoses and developmental levels, and by cultural influences. This chapter summarizes definitions and classifications of pain, including total pain. It looks at ways that children express pain, and measurement of pain severity. Pharmacological treatment of pain is considered, alongside the World Health Organization pain guidelines, which are considered to be the basis of managing pain in palliative care.

Ethnic and cultural aspects of palliative care

2015 ◽  
Author(s):  
LaVera Crawley ◽  
Jonathan Koffman
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
World Health ◽  
Life Care ◽  
Cultural Aspects ◽  
Physical Conditions ◽  
Appropriate Treatment ◽  
Definition Of ◽  
Health Organization

This chapter attempts to identify ‘differences that make a difference’ when individuals and groups negotiate institutions and practices for palliative and end-of-life care. Two influences on the practice of palliative care-immigration and health disparities-are examined. The World Health Organization definition of palliative care specifies two goals: improving quality of life of patients and families and preventing and relieving suffering. It identifies three ‘colour blind’ strategies for meeting those goals: early identification, impeccable assessment, and (appropriate) treatment. Lastly, the definition addresses four domains of care: (1) problems related to pain, (2) physical conditions, (3) the psychosocial, (4) and the spiritual. This chapter specifically addresses these goals, strategies, and domains in relation to delivering quality palliative care in cross- or multicultural settings.

Essential medicines for palliative care

2015 ◽  
Author(s):  
Liliana De Lima ◽  
Lukas Radbruch ◽  
Eduardo Bruera
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
International Association ◽  
Cost Effective ◽  
Access To Medicines ◽  
Essential Medicines ◽  
World Health ◽  
Care Needs ◽  
Health Organization ◽  
Hospice And Palliative Care

The essential medicines concept developed by the World Health Organization (WHO), states that there is a list of minimum medicines for a basic health-care system, including the most efficacious, safe, and cost-effective ones for priority conditions. According to the WHO, essential medicines are those that satisfy the primary health-care needs of the population. Thus, they should always be available, affordable, and cost-effective. However, the vast majority of the global population does not have access to essential medicines. Many organizations have called on governments to adopt policies to improve availability of these essential medicines and developed programmes and projects to increase awareness and knowledge. This chapter describes two such projects developed by the International Association for Hospice and Palliative Care (IAHPC), based on the essential medicines concept to improve access to medicines and appropriate palliative care: the IAHPC List of Essential Medicines in Palliative Care and the Opioid Essential Prescription Package.

Palliative care in the intensive cardiac care unit

2015 ◽  
Author(s):  
Jayne Wood ◽  
Maureen Carruthers
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Control ◽  
World Health ◽  
Terminal Phase ◽  
Cardiac Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Cardiac Care Unit

Specialist palliative care services originally focused on improving the quality of life for patients with a diagnosis of cancer in the terminal phase of their illness. However, organizations, such as the World Health Organization, supported by recent national strategies, such as the End of Life Care Strategy (United Kingdom, 2008), promote the early integration of specialist palliative care into the management of patients with incurable disease, irrespective of the diagnosis. The primary goal of the intensive cardiac care unit is to help patients survive acute threats to their lives. However, the suddenness and severity of illness, particularly when associated with an underlying cardiological diagnosis, often means that the provision of optimal specialist palliative care is challenging. This chapter addresses key issues relating to the provision of specialist palliative care in the challenging and complex environment of the intensive cardiac care unit, including symptom control, end of life care, decision making, and communication. The benefits of multidisciplinary working for effective quality improvement in patient care and best support for patients, families/carers, and staff are also addressed. The importance of interdisciplinary working is highlighted, and, by embedding the principles of holistic care into daily practice, the intensive cardiac care unit can ensure that patients and their families/carers receive the support they need in a timely manner from individuals who are well supported in what is often considered to be one of the most challenging medical environments.

scholarly journals The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS

2019 ◽  
Vol 35 (7) ◽  
Author(s):  
Shamyr Castro ◽  
Camila Ferreira Leite ◽  
Michaela Coenen ◽  
Cassia Maria Buchalla
Keyword(s):  
Public Health ◽  
World Health ◽  
Clinical Settings ◽  
Patient Centered ◽  
Public Health Perspective ◽  
Death Rates ◽  
The Public ◽  
Whodas 2.0 ◽  
Health Organization ◽  
Functioning Assessment

Functioning and disability are concepts in increasing use in clinical settings and in public health. From the public health perspective, the use of functioning as a third health indicator could show more than the frequency of a disease and its death rates, offering information on how the population performs its activities and participation. Clinically, the functioning assessment can provide information for patient-centered health care and specific clinical interventions according to their functioning profile. WHODAS 2.0 is a generic tool to assess health and functioning according to the ICF functioning model. It is an alternative to assess functioning in a less time-consuming way, whereas the duration of the application is one of the main ICF critiques. This paper aims to present some of WHODAS 2.0 inconsistencies and weaknesses as well as strategies to cope with them. In this paper, we present some weaknesses related to the WHODAS layout; wording and scoring process. Some suggestions for strategies to correct these weaknesses are presented, as well.

Sign in / Sign up

Export Citation Format

Share Document