Discussing patient preferences for levels of life-sustaining treatment: development and pilot testing of a Danish POLST form

Background Medically frail and/or chronically ill patients are often admitted to Danish hospitals without documentation of patient preferences. This may lead to inappropriate care. Modelled on the American Physician Orders for Life-Sustaining Treatment (POLST) form, the purpose of the study was to develop and pilot test a Danish POLST form to ensure that patients’ preferences for levels of life-sustaining treatment are known and documented. Methods The study was a mixed methods study. In the initial phase, a Danish POLST form was developed on the basis of literature and recommendations from the National POLST organisation in the US. A pilot test of the Danish POLST form was conducted in hospital wards, general practitioners’ clinics, and nursing homes. Patients were eligible for inclusion if death was assessed as likely within 12 months. The patient and his/her physician engaged in a conversation where patient values, beliefs, goals for care, diagnosis, prognosis, and treatment alternatives were discussed. The POLST form was completed based on the patient’s values and preferences. Family members and/or nursing staff could participate. Participants’ assessments of the POLST form were evaluated using questionnaires, and in-depth interviews were conducted to explore experiences with the POLST form and the conversation. Results In total, 25 patients participated, 45 questionnaires were completed and 14 interviews were conducted. Most participants found the POLST form readable and understandable, and 93% found the POLST form usable to a high or very high degree for discussing preferences regarding life-sustaining treatment. Three themes emerged from the interviews: (a) an understandable document is essential for the conversation, (b) handling and discussing wishes, and (c) significance for the future. Conclusion The Danish version of the POLST form is assessed by patients, families, physicians, and nurses as a useful model for obtaining and documenting Danish patients’ preferences for life-sustaining treatment. However, this needs to be confirmed in a larger-scale study.

Storming the Bastille of Orthodoxy

After describing orthodox medicine and its alternatives in early America, this chapter discusses the rise of country’s earliest medical licensing laws, in the late eighteenth and early nineteenth centuries. These schemes strove to exclude unorthodox practitioners from the medical profession. American arguments for freedom of therapeutic choice were born in opposition to these original licensing systems. The chapter examines in detail the medical liberty advocacy of Benjamin Rush, an influential Founding Father who was also the most prominent American physician of the early national period. The chapter analyzes the genesis during this time of various strains of medical freedom rhetoric that would persist, to varying degrees, throughout American history.

What is the placebo effect?

For the first time, the placebo effect was described in 1955 by the American physician Henry Beecher, who found that about a third of patients recover as a result of the use of sugar pills that do not contain any active medicinal substances. The first mentions of such drugs date back to the 18th century; at that time they meant "fake" drugs containing indifferent substances in their composition. It is believed that the placebo effect is associated with a person's psycho-emotional perception of this drug as a means of salvation, belief in its effectiveness and efficacy, and the desire to recover. Against this background, the maximum mobilization of vital forces occurs, the processes of regeneration are switched on, and the physical and mental state of the patient is normalized. An interesting fact is that the severity of the placebo effect can be significantly affected by the cost of the drug (the higher it is, the better the drug "helps") and even its appearance. For instance, yellow pills are very effective in treating depression, green pills help reduce feelings of anxiety, and white pills assist in treating stomach ulcers. In addition, taking two pills has a greater positive effect than taking one.

James McCune Smith Predicted African American Preeminence in U.S. Art and Culture

James McCune Smith (1813–1865) was an African American physician, author, intellectual, community leader, and antislavery activist. He believed that the racial caste system of the United States was perpetuated not only by the slave system but by widely entrenched negative attitudes towards people of African descent, both outside and within the African American community. To counteract popular prejudice and to promote African American confidence and unity, he wrote widely on the abilities, accomplishments, and contributions of people of African descent, both historical and contemporary. This article examines McCune Smith’s theory that African Americans would play a formative and outsize role in the development of United States artistic and intellectual culture. From his time to ours, McCune Smith’s striking prediction was fulfilled to a degree that even he, inspired with the confidence his 1841 lecture “The Destiny of the People of Color” (published 1843) reveals, might marvel at.