scholarly journals A autonomia da vontade no fim da vida e o direito de antecipar escolhas / The autonomy of will at the end of life and the right to anticipate choices

2021 ◽  
Vol 7 (9) ◽  
pp. 90403-90418
Author(s):  
Carlota Assayag Mendes ◽  
José Roque Nunes Marques
Keyword(s):  
End Of Life ◽  
The Right ◽  
Autonomy Of Will

scholarly journals 77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
D Hibbert
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Plan ◽  
Specialist Palliative Care ◽  
Experience Of Care ◽  
Outcomes Of Care ◽  
Specialist Palliative Care Service ◽  
The Right

Abstract   NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

scholarly journals Facing Death: Attitudes toward Physician-Assisted End of Life among Physicians Working at a Tertiary-Care-Hospital in Israel

2021 ◽  
Vol 18 (12) ◽  
pp. 6396
Author(s):  
Keren Dopelt ◽  
Dganit Cohen ◽  
Einat Amar-Krispel ◽  
Nadav Davidovitch ◽  
Paul Barach
Keyword(s):  
End Of Life ◽  
Tertiary Care Hospital ◽  
Human Life ◽  
Tertiary Care ◽  
Terminally Ill ◽  
Background Information ◽  
Care Hospital ◽  
Medical Assistance In Dying ◽  
Terminally Ill Patients ◽  
The Right

The demand for medical assistance in dying remains high and controversial with a large knowledge gap to support optimal patient care. The study aimed to explore physicians’ attitudes regarding euthanasia and examine the factors that related to these attitudes. We surveyed 135 physicians working at a tertiary-care hospital in Israel. The questionnaire was comprised of demographic and background information, DNR procedure information, encounters with terminally ill patients, familiarity with the law regarding end-of-life questions, and Attitudes toward Euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should be allowed, while 29% thought that physicians should preserve a patients’ life even when they expressed the wish to die. A negative statistically significant relationship was found between the level of religiosity and attitudes toward euthanasia. The physicians’ attitudes towards euthanasia are quite positive when compared to other countries. The data shows a conflict of values: the sacredness of human life versus the desire to alleviate patients’ suffering. The Coronavirus-19 outbreak reinforces the importance of supporting physicians’ efforts to provide ethical and empathic communication for terminally ill patients. Future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to end-of-life requests.

scholarly journals Ευθανασία: Πρακτικές που εφαρμόζουν οι χώρες της Ευρωπαϊκής Ένωσης

Bioethica ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. 89
Author(s):  
Αλεξάνδρα Κοζαμάνη (Alexandra Kozamani)
Keyword(s):  
European Union ◽  
End Of Life ◽  
The Other ◽  
Self Determination ◽  
Healthcare Personnel ◽  
The European Union ◽  
Other Hand ◽  
Receive Treatment ◽  
The Right

Euthanasia is one of the issues that bioethics deals with, which is one of the outmost importance. Furthermore it is very up-to-date. In Greece and in most countries of the European Union euthanasia has not been subject to specialized legislation. It is only occasionally debated, resulting in tension and conflict. On one hand, people have the right to self determination, so the end of life should be among them. On the other hand, life is considered to be of the highest value and it is the duty of healthcare personnel to guard and preserve it by any means, using their expertise and knowledge.In this paper, a brief report is made to the practices used across countries in the European Union regarding the end of life. Most countries are opposed to euthanasia while acknowledging the right of a patient to refuse or receive treatment. Only three countries have passed bills that legalize euthanasia under strict conditions. The rest, due to sensitivity in this matter, have not yet proceeded in reforming their laws accordingly. It seems that society does not have the necessary reassurances so that they can engulf that issue guarding the true will of a person.

scholarly journals Medicine Facing Death: Attitudes Toward Physician-Assisted End of Life – A Cross-Sectional Study

2021 ◽  
Author(s):  
Keren Dopelt ◽  
Dganit Cohen ◽  
Einat Amar-Krispel ◽  
Davidovitch ◽  
Paul Barach
Keyword(s):  
End Of Life ◽  
Human Life ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Medical Assistance In Dying ◽  
Empathic Communication ◽  
Wish To Die ◽  
The Right

Abstract Background: The demand for medical assistance in dying remains high and controversial. The "Dying Patient Act" (2005) legalized requiring Israeli patients to receive medical guidance regarding the care (or non-treatment) they seek at the end of life. Many doctors have made it clear that helping a patient die is opposed by their values and professional goals.Objective: To explore the attitudes of physicians regarding euthanasia and examine the factors that related to these attitudes.Methods: We conducted a cross sectional prospective study in Israel, during January-February 2019. We used logistic regression analyses to describe the association of demographic and professional factors with attitudes toward physician-assisted end of life.Results: We surveyed 135 physicians working at a tertiary-care-hospital about their attitudes regarding euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should be allowed, while 29% thought that physicians should preserve a patient's life even if they expressed the wish to die. Conclusion: The data shows a conflict of values: the sacredness of human life versus the desire to alleviate patient's suffering. Coronavirus outbreak reinforces the urgency of our findings and raises the importance of supporting physicians' efforts to provide ethical, and empathic communication for terminally ill patients. Future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to end-of-life requests.

VII. Reason as a Mystagogue: Plutarch's View of God

2017 ◽  
Vol 47 ◽  
pp. 145-166
Keyword(s):  
End Of Life ◽  
Philosophical Thinking ◽  
Rational Thinking ◽  
Decisive Influence ◽  
The Right ◽  
Correct Understanding ◽  
Insight Into

It is not only Alexander alone who has the right to be proud because he rules over many men, but no less right to be proud have they who have true notions concerning the gods. This quotation from a letter of Aristotle to Antipater (fr. 664 Rose) repeatedly occurs in the Plutarchan corpus. Plutarch clearly agreed. He regarded rational thinking about the gods as a human's most divine possession and as the most decisive influence on their happiness (De Is. et Os. 378C–D), and, as we have already seen, he adopted the Platonic phrase of ὁμοίωσις θεῷ (κατὰ τὸ δυνατόν) (‘assimilation to God [as far as possible]’) as the final end of life (see above, Chapter II, §1). In several ways, then, God is, as it were, the keystone that lends bearing power to the whole vault of Plutarch's philosophical thinking. A correct understanding of his thought therefore presupposes a deeper insight into his conception of God.

Cosa voglio fare alla fine della vita? Consapevolezza della malattia, conoscenza delle procedure cliniche e delle direttive anticipate in pazienti con malattie croniche progressive / What do I want to be done at end-of-life? Disease awareness, knowledge of clinical procedures and of advanced directives in patients with chronic progressive diseases

2018 ◽  
Vol 67 (1) ◽  
pp. 11-24
Author(s):  
Anna Giardini ◽  
Marcella Ottonello ◽  
Carlo Pasetti ◽  
Debora Pain ◽  
Ines Giorgi
Keyword(s):  
End Of Life ◽  
Chronic Kidney Failure ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Advanced Directives ◽  
Disease Awareness ◽  
Clinical Procedures ◽  
Mediterranean Countries ◽  
The Right ◽  
Als Patients

Scopo del nostro studio osservazionale cross-sectional è di studiare la consapevolezza di malattia, la conoscenza delle procedure cliniche e delle dichiarazioni anticipate di trattamento in pazienti italiani affetti da patologie croniche progressive. Metodo. Sono stati valutati 115 soggetti (23 con Sclerosi Laterale Amiotrofica – SLA; 30 con Scompenso Cardiaco Cronico – SCC; 32 con Insufficienza Renale Cronica – IRC; 30 con Tumore Avanzato –TA) su: conoscenza sui temi della salute, diritto ad essere informati, significato delle Direttive Anticipate (DA) e delle Dichiarazioni Anticipate di Trattamento (DAT). Risultati. 86% dei pazienti hanno evidenziato il diritto di conoscere diagnosi e prognosi e di essere informati sull’evoluzione di malattia. Molti pazienti non conoscevano il significato di procedura invasiva (52%) o di trattamento aggressivo (81%). Il 72% non conosceva il significato di DA e di DAT; il 94% riteneva che le DA o le DAT potessero parzialmente o totalmente garantire il desiderio del paziente di prendere parte alle decisioni sulla gestione del fine vita. Una volta informati sul significato delle AD (vincolanti) e delle DAT (non vincolanti) I pazienti con SLA preferivano la scelta di direttive vincolanti rispetto ai pazienti con TA e con SCC (SLA vs SCC p=.005; SLA vs TA p=.001). I pazienti con IRC preferivano direttive vincolanti rispetto ai pazienti con SCC (p=.02). Conclusioni. Deve essere parte integrante nella pratica clinica l’informare e il guidare il paziente dal momento della diagnosi fino alle fasi ultime di vita. ---------- Introduction. Many steps forward within the legal field to facilitate end-of-life communication have been taken, but Mediterranean countries can be considered as a step back. Aim of our observational cross-sectional study is to observe disease awareness, knowledge of clinical procedures and of advanced directives in patients with chronic progressive diseases in Italy. Methods. 115 subjects (23 with Amyotrophic Lateral Sclerosis – ALS, 30 with Chronic Heart Failure - CHF, 32 with Chronic Kidney Failure – CKF, and 30 with Advanced Cancer – AC) were assessed on health literacy, their right to be informed and meaning of Advance Directives (AD) and of Advance Declaration of Treatment (ADT). Results. 86% of patients claimed the right to know diagnosis and prognosis and to be informed of disease progression. Patients did not know the meaning of invasive therapy (52%) and of aggressive treatment (81%). 72% did not know the meaning of AD and of ADT; 94% believed that AD or ADT could partially or totally guarantee patient’s will to make decisions on end-of-life, with frequency difference on AD or ADT efficiency between CHF and ALS patients (p=.01). Once informed on the definitions of AD (legally binding) and ADT (not legally binding), ALS patients preferred legally binding directives, compared to patients with AC and with CHF (ALS vs CHF p=.005; ALS vs AC p=.001). Patients with CKF would prefer legally binding proposal compared to CHF patients (p=.02). Conclusion. To inform and to guide patients from diagnosis to end-of-life should be an integral part of medical practice.

scholarly journals 309 The Growing Need for Advance Care Planning Discussion: An Admission to Die for?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Aoife McFeely ◽  
Cliona Small ◽  
Susan Hyland ◽  
Jonathan O'Keeffe ◽  
Graham Hughes ◽  
...  
Keyword(s):  
Palliative Care ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
Early Decision ◽  
One Year ◽  
The Right

Abstract Background Older people living in nursing homes (NHs) are among the most frail and vulnerable in our community. Over the last 5 years, a review of our local NH admission database revealed a 7% increase in the number of unscheduled hospital attendances from NHs (1015 in 2012/13 vs 1435 in 2016/17). Additionally we have seen an increase in the number of NH residents experiencing ≥2 unscheduled re-admissions within one year (21.1% in 2012/13 vs 30.45% in 2016/17). Our aim was to examine the proportion of patients from NHs who died within 24 hours of presentation, prompting a review of methods that could prevent inappropriate hospital transfers and promoting dignified and comfortable end of life care. Methods A prospective database was collected between 01/01/2016 - 31/12/2017. This recorded all emergency admissions of older people from NHs recording length of stay, readmission rates and mortality. The data was retrospectively analysed, looking specifically at patients who died in hospital ≤ 24 hours Results Of 1435 ED admissions, 49 patients (3.4%) died in hospital ≤ 24 hours after presentation. Of these, 31 patients (61%) died in palliative care suites. 8 patients (16.3%) died in the ED. Conclusion A small number of NH residents presenting to our hospital died within 24 hours. A large proportion of these patients died in a palliative care suite, suggesting poor prognosis was identified rapidly after presentation. We wonder if some of these hospital transfers were avoidable and could certain patients have experienced less disruptive deaths in their NHs? Advanced Care Planning can be difficult for all involved. However, it plays an essential role in ensuring people receive the right care, at the right time, in the right place, from the right team. We support the collaborative roles of a palliative care CNS or Geriatric ANP, and integration with NH Outreach services, to facilitate early decision-making and promote better end of life care.

scholarly journals On the Likelihood of Surrogates Conforming to the Substituted Judgment Standard When Making End-of-Life Decisions for Their Partner

2019 ◽  
Vol 39 (6) ◽  
pp. 651-660 ◽  
Author(s):  
Eleonore Batteux ◽  
Eamonn Ferguson ◽  
Richard J. Tunney
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Real Life ◽  
Considerable Proportion ◽  
Next Of Kin ◽  
Substituted Judgment ◽  
End Of Life Decisions ◽  
Life Decisions ◽  
The Right ◽  
Substituted Judgment Standard

A considerable proportion of end-of-life decisions are made by the patient’s next-of-kin, who can be asked to follow the substituted judgment standard and decide based on the patient’s wishes. The question of whether these surrogate decision makers are actually able to do so has become an important issue. In this study, we examined how the likelihood of surrogates conforming to the substituted judgment standard varies with individual differences in mortality acceptance and confidence in their decision making. We recruited 153 participants in romantic relationships between 18 and 80 years old from the general population. We asked them to make hypothetical end-of-life decisions for themselves and on behalf of their partner, as well as predict what their partner would do, and complete a series of questionnaires. Participants predicted that their partner would make similar decisions to their own but were more likely to accept a life-saving treatment that could result in reduced quality of life on their partner’s behalf than for themselves. Decisions made by older adults were more likely to conform to the substituted judgment standard, which is encouraging given that they are more likely to be confronted with these decisions in real life, although this was not due to differences in mortality acceptance. Older adults were also more likely to have had previous discussions with their partner and thereby know that person’s wishes and feel confident that they made the right decision, but these factors did not affect their likelihood of conforming to the substituted judgment standard. This shows that encouraging discussions about end of life among families would ease the decision process, but more work is needed to ensure that surrogates can adhere to the substituted judgment standard.

End-of-Life Decision-Making

2017 ◽  
Author(s):  
Chad D. Kollas ◽  
Beth Boyer Kollas
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
End Of Life ◽  
Planning Process ◽  
Legal Reasoning ◽  
The United States ◽  
Medical Decision ◽  
The Right ◽  
End Of Life Decision ◽  
Life Decision

Growth in the size and wealth of the United States’ elderly population, coupled with a trend toward increasing patient autonomy, has created an environment for increased conflict in end-of-life decision-making. This chapter explores the required elements for making decisions at the end of life, including determination of medical decision-making capacity. Also discussed is the development of the legal reasoning that governs situations involving elderly patients who lack the capacity, but retain the right, to make medical decisions. The chapter describes the utility of the advance care planning process, by which elderly patients can make their preferences for medical treatment known in advance of conditions or illness that could result in cognitive impairment that would otherwise hamper their ability to participate personally in end-of-life decisions. Finally, a variety of forms of advance directives are described, critical tools in honoring the medical autonomy of elderly patients.

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