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1
Kellehear, Allan. "Is “Healthy Dying” a Paradox? Revisiting an Early Kastenbaum Challenge." OMEGA - Journal of Death and Dying 70, no. 1 (November 2014): 43–55. http://dx.doi.org/10.2190/om.70.1.e.
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This article is a review of Robert Kastenbaum's 1979 essay entitled “Healthy dying: A paradoxical quest continues.” It begins with a summary of the arguments and challenges in the original essay. This is followed by an evaluation of his original claims in the light of contemporary insights in modern public health history and empirical studies of near-death experiences and deathbed visions. The recent development of health promotion in palliative care is described in relation to these developments and Kastenbaum's early question about the paradoxical quest for health while dying is again posed against this background. Given our modern understanding of “health” in current global health policy and debates, it is argued that “healthy dying” is no paradox. Instead, the pursuit of health at the end of life represents a realistic modern desire to compress morbidity, minimize unnecessary suffering, and enhance quality of life at this time.
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Petty, Eric, Bert Hayslip, Daniela M. Caballero, and Sharon Rae Jenkins. "Development of a Scale to Measure Death Perspectives." OMEGA - Journal of Death and Dying 71, no. 2 (March 16, 2015): 146–68. http://dx.doi.org/10.1177/0030222815570597.
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Kastenbaum and Aisenberg have suggested that persons can cope with the impact of death and dying by altering their understanding of what each means to them as well as by changing their behavioral responses to such experiences. The present study’s purpose was to develop a reliable and valid measure to assess an individual’s particular death perspective based on Kastenbaum and Aisenberg’s distinctions between overcomers and participators. The Death Perspective Scale developed here assessed the extent to which individuals utilize either an overcoming or participating approach to (a) assigning meaning to dying and death and (b) behaviorally responding to death-related experiences. Based upon the data collected from 168 adults varying by age and gender, findings suggested that both overcoming and participating could be reliably assessed, correlated with measures of death anxiety and death attitudes, and varied reliably ( p < .05) by age and gender, wherein such differences were for the most part consistent with predictions by Kastenbaum and Aisenberg espoused over 30 years ago. Findings here suggested that overcomers reported more fear of death and dying and were less accepting in this respect, while participators reported fewer death-related fears and were more accepting. Women and older adults were more participating, while men and younger adults were more overcoming, though such effects varied depending upon whether meaning versus response to death was considered. The consistency between the present findings and the predictions Kastenbaum and Aisenberg suggests that while person’s orientations to death and dying seem to transcend sociocultural change, empirically based efforts to better understand how our death system impacts persons need to move forward.
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Corless, Inge B. "Transitions: Exploring the Frontier." OMEGA - Journal of Death and Dying 70, no. 1 (November 2014): 57–65. http://dx.doi.org/10.2190/om.70.1.f.
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End-of-life experiences go by various terms, including near-death experiences (NDEs), deathbed visions, deathbed phenomena, deathbed coincidences, and nearing death awareness. Deathbed escorts is the term applied to the vision of deceased family members or friends who inform the dying person that they will be accompanied in the transition from life. In this article, I examine the subject of NDEs and deathbed escorts, starting with the rich body of work provided by Robert and Beatrice Kastenbaum. A subject of some interest to Robert Kastenbaum, he explored this frontier in his many writings on dying, death, and bereavement. Ever the pioneer and having made the ultimate transition, he may yet be exploring new frontiers.
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Wittkowski, Joachim. "Consensus, Dissension, and Admiration: Encounters with Robert Kastenbaum and His Work." OMEGA - Journal of Death and Dying 70, no. 1 (November 2014): 133–41. http://dx.doi.org/10.2190/om.70.1.k.
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The article sheds light on the way the author's scientific views and endeavors in the field of dying, death, and bereavement over 40 years in Germany have been influenced by the work of Robert Kastenbaum. Reconstructing the passage of time, the early years (i.e., the second half of the 1970s), a middle period (i.e., the 1980s and 1990s), and the later years (i.e., from the turn of the century to the present) are outlined. In an anecdotic fashion, two personal encounters with R. Kastenbaum are reported. The article concludes with showing/consensus and dissention in various respects and finally recounts the author's admiration for this outstanding scholar.
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Vachon, Mary L. S. "The Impact of the Document International Work Group in Death, Dying and Bereavement: Assumptions and Principles Underlying Standards for Terminal Care." OMEGA - Journal of Death and Dying 70, no. 1 (November 2014): 27–41. http://dx.doi.org/10.2190/om.70.1.d.
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This article reflects on the development and impact of the International Workgroup on Death, Dying and Bereavement's (IWG) pivotal document on The Assumptions and Principles Underlying Standards for Terminal Care. It was at the Ars Moriendi meetings in Columbia, Maryland that the author first met Bob and Bunny Kastenbaum. The meeting led to the development of IWG and the first task of this group was the development of the “Standards” document. The initial document reflected the pioneering work already being done by Kastenbaum and others on the committee and then was formative in the development of other documents such as the National Hospice Association Standards. Participants in the original workgroup were asked for their reflections on the significance of the document and the literature was surveyed to assess the impact of the “Standards” document on the field.
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Thistlethwaite, Jill. "Death and dying: the ultimate challenge." Clinical Teacher 16, no. 6 (November 17, 2019): 557–58. http://dx.doi.org/10.1111/tct.13115.
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Todd, Stuart. "death counts: the challenge of death and dying in learning disability services." Learning Disability Practice 7, no. 10 (December 2004): 12–15. http://dx.doi.org/10.7748/ldp2004.12.7.10.12.c1551.
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Gamlin, Richard. "Book Review: Dying, Death and Bereavement: A Challenge for Living." Palliative Medicine 18, no. 6 (September 2004): 580. http://dx.doi.org/10.1177/026921630401800615.
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Gullickson, Terri. "Review of A Challenge for Living: Dying, Death, and Bereavement." Contemporary Psychology: A Journal of Reviews 41, no. 3 (March 1996): 287. http://dx.doi.org/10.1037/002832.
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&NA;. "Dying, Death, and Bereavement: A Challenge for Living (2nd Ed.)." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 22, no. 11 (November 2004): 795. http://dx.doi.org/10.1097/00004045-200411000-00020.
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Bird, Jessica Nancy. "Death and dying in a Karen refugee community: An overlooked challenge in the resettlement process." Ethnography 20, no. 4 (April 9, 2018): 443–62. http://dx.doi.org/10.1177/1466138118768624.
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This paper explores death and dying in a settling refugee community. I use ethnographic description to explore an overlooked practical challenge of resettlement – funerals. The focus of research is the Brisbane Karen community, from Burma and/or Thai-Burma border camps. Death and dying as a theme of resettlement research is inadequate. Yet we ought to consider death and dying as a settlement challenge, just as we consider language, employment, or housing (for example). Death and dying traverses the practical challenges of settlement, to deeper ontological questions associated with spiritual existence, rituals and community bonding. The paper provides practical insights into the basic boundaries of Australian funeral practice, which can speak to other minority groups practising burial rites that depart from the mainstream. It comments on how those boundaries can bump up against cultural practice brought from elsewhere. It also demonstrates transnationalism in the Brisbane Karen community.
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Golla, Heidrun, Maren Galushko, Julia Strupp, Ute Karbach, Holger Pfaff, Christoph Ostgathe, and Raymond Voltz. "Patients Feeling Severely Affected by Multiple Sclerosis." OMEGA - Journal of Death and Dying 74, no. 2 (August 3, 2016): 275–91. http://dx.doi.org/10.1177/0030222815598443.
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Eleven months after being interviewed in a study on unmet needs of severely affected multiple sclerosis patients, one participant died by assisted suicide. We reanalyzed the data to find out if our 15 study patients might have brought up the topic of death and dying during episodic interviews that had not primarily addressed this issue. Secondary analysis with regard to the thematic field of death and dying revealed that patients unsolicited brought up this issue within the following categories: “Passing over death and dying,” “Death is not relevant to me,” “We want to keep up the life challenge,” “Death as an option,” and “Wish to have the opportunity to address end of life issues.” We conclude that the topic of death and dying is of importance to these patients, as they spontaneously mentioned it in multiple varieties. Health professionals should individually acknowledge patients' needs to address death and dying.
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Miller, Franklin G. "The Good Death, Virtue, and Physician-Assisted Death: An Examination of the Hospice Way of Death." Cambridge Quarterly of Healthcare Ethics 4, no. 1 (1995): 92–97. http://dx.doi.org/10.1017/s0963180100005703.
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The problem of physician-assisted death (PAD), assisted suicide and active euthanasia, has been debated predominantly in the ethically familiar vocabulary of rights, duties, and consequences. Patient autonomy and the right to die with dignity vie with the duty of physicians to heal, but not to kill, and the specter of “the slippery slope” from voluntary euthanasia as a last resort for patients suffering from terminal illness to PAD on demand and mercy killing of “hopeless” incompetent patients. Another dimension of the debate over PAD concerns the evaluative question of what constitutes a good death. At stake are Issues of character and virtue in the face of death and dying and their Implications for legitimizing the practice of PAD. Critics of PAD argue that “natural” death in the context of comfort care, as provided by hospice programs, is the good death. In contrast, PAD amounts to an easy way out, an evasion of the ultimate human challenge and task of dying. Because hospice care is clearly preferable to PAD, the former should be encouraged and the latter remain prohibited.
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Foti, Megan, and Stacy Cassel. "EXPLORING DEATH AND DYING WITH HEALTHCARE STUDENTS." Innovation in Aging 3, Supplement_1 (November 2019): S726—S727. http://dx.doi.org/10.1093/geroni/igz038.2662.
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Abstract Although death is a universal experience, many avoid discussing or learning more about the topic (Mak, 2011). However, healthcare professionals are expected to be knowledgeable, resourceful, and professional within their scopes of practice, but oftentimes avoid end of life topics (Ramvi & Gripsrud, 2017). Students also report concerns when working with clients at the end of life expressing fear of how they will handle an encounter with a dying client (Ek et al., 2014). Therefore, professionals need didactic and personal preparation to be more comfortable with discussions related to end of life treatment and planning (Kumar et al, 2013). Evidence supports that students can benefit from self-reflective and narrative exercise with older adults that challenge their perspectives on end of life. Students who are able to openly discuss death, dying, illness and loss express a desire to learn more about working with the older adult population and increased sensitivity to the beliefs and attitudes of older adults (Butler & Baghi, 2008; Nelson et al., 2018). In order to provide students with an opportunity to explore end of life topics, professors designed an educational module which included activities such as writing a living will, discussing end of life topics with older adults, and critically reflecting on their experiences. This proposed poster will highlight current background literature relevant to end of life topics, methods for integrating end of life topics into academic curricula, and student perceptions related to end of life topics as shared in their reflections.
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Coleman, Carl H., and Alan R. Fleischman. "Guidelines for Physician-Assisted Suicide: Can the Challenge Be Met?" Journal of Law, Medicine & Ethics 24, no. 3 (1996): 217–24. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01855.x.
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The question of legalizing physician-assisted suicide (PAS) has become a serious public debate. Growing interest in assisted suicide reflects a public increasingly fearful of the process of dying, particularly the prospect of dying a painful, protracted, or undignified death. PAS has been proposed as a compassionate response to unrelievable suffering, designed to give terminally or incurably ill individuals direct control over the timing, manner, and circumstances of their death. Although the American Medical Association remains firmly opposed to legalizing PAS, many physicians have begun to express support for the practice, and some have acknowledged that they have helped patients commit suicide despite the existing legal ban.As support for PAS grows, it becomes increasingly likely that the practice will be legalized in at least some states in the not-too-distant future. In 1994, Oregon voters approved a referendum legalizing PAS for competent, terminally ill patients; a federal court injunction preventing the referendum from going into effect is currently on appeal, and it is widely expected that the injunction will be lifted.
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Rubin, Simon Shimshon. "Loss and Mourning in the Jewish Tradition." OMEGA - Journal of Death and Dying 70, no. 1 (November 2014): 79–98. http://dx.doi.org/10.2190/om.70.1.h.
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Robert Kastenbaum was a man who helped reintroduce issues related to death, dying, and bereavement to academic, clinical, and general discourse. This article, devoted to an encounter with the observance of mourning custom and ritual in the Jewish tradition, continues the dialogue in this journal that Bob founded. The article utilizes the Two-Track Model of Bereavement to address the Jewish tradition's structuring of the loss experience. After a brief introduction, I present a schematic presentation of some of the issues operant in grief and mourning for the believer. This is followed by two responses to loss that portray the pain of loss in the tradition. The article goes on to consider the Jewish time cycle of response to loss—from preburial Aninut, to Shiva, the first week, to Shloshim, the first month, to Shanah, the first year, to the expectations for encounters across the life cycle. The Yizkor and Kaddish are also considered. In the Jewish tradition, alongside attention to what level of functioning to require of the bereaved, there are lifelong opportunities to rework and maintain connection to the memories, associations, narratives, and experiences that comprise the psychological organization of the continuing bond and relationship to the deceased.
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Guha, Martin. "Macmillan Encyclopedia of Death and Dying2003241Editor‐in‐Chief Robert Kastenbaum. Macmillan Encyclopedia of Death and Dying. New York, NY: Macmillan Reference 2003. 2 vols, ISBN: 0 02 865689 X $300." Reference Reviews 17, no. 5 (May 2003): 27–28. http://dx.doi.org/10.1108/09504120310480940.
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Ekendahl, Karl. "Abortion and the Epicurean challenge." Journal of Medical Ethics 46, no. 4 (October 19, 2019): 273–74. http://dx.doi.org/10.1136/medethics-2019-105771.
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AbstractIn a recent article in this journal, Anna Christensen raises an ‘Epicurean challenge’ to Don Marquis’ much-discussed argument for the immorality of abortion. According to Marquis’ argument, abortion is pro tanto morally wrong because it deprives the fetus of ‘a future like ours’. Drawing on the Epicurean idea that death cannot harm its victim because there is no subject to be harmed, Christensen argues that neither fetuses nor anyone else can be deprived of a future like ours by dying. Thus, Christensen suggests, the moral wrongness of abortion (and other killings) cannot be grounded in the relevant individual’s being deprived of a future like ours. In this reply, I argue that on no interpretation of Christensen’s Epicurean challenge does it succeed.
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Hall-Lord, Marie Louise, Kerstin Petzäll, and Birgitta Hedelin. "Norwegian and Swedish nursing students’ concerns about dying." Nordic Journal of Nursing Research 38, no. 1 (May 23, 2017): 18–27. http://dx.doi.org/10.1177/2057158517709408.
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Providing care for dying patients is demanding for nurses. The aim of this study was to investigate Norwegian and Swedish nursing students’ concerns about dying and sense of coherence in their first and third year. Further, to describe the students’ experiences of caring for dying patients during their education. Nursing students in their first and third year in Norway ( n = 64) and Sweden ( n = 79) responded to the questionnaire Concerns about Dying and Sense of Coherence Scale. Interviews were conducted with 11 students. In their third year, both groups reported reduced concerns with regard to their own death. Norwegian students with no experience in healthcare before education reported more concerns about dying patients. Caring for a dying patient was experienced as a challenge to endure, perform and learn. There is a need to develop teaching methods and to give individualized support to nursing students during their education.
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Almeida, Fabiane de Amorim, Mariana Salim de Moraes, and Mariana Lucas da Rocha Cunha. "Taking care of the newborn dying and their families: Nurses' experiences of neonatal intensive care." Revista da Escola de Enfermagem da USP 50, spe (June 2016): 122–29. http://dx.doi.org/10.1590/s0080-623420160000300018.
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Objective To understand the experiences of nurses when caring for dying newborns and their families in the NICU; and redeem their perceptions about acting before the death and grieving process. Method A descriptive exploratory study with a qualitative approach, developed with nine nurses at the ICU of a hospital in São Paulo (SP), Brazil. Data was collected through semi-structured interviews and analyzed using the Collective Subject Discourse (CSD). Results Caring for newborns who are dying and their families is very difficult for nurses, due to the intense involvement. They seek strategies to deal with the situation and, before the newborn’s death, despite the suffering, express the feeling of accomplishment. Conclusions Facing death and grief triggers mechanisms that emerge life references, coming across painful issues. Learning to deal with these questions is a daily challenge for nurses of the NICU.
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BRYSON, KENNETH A. "Spirituality, meaning, and transcendence." Palliative and Supportive Care 2, no. 3 (September 2004): 321–28. http://dx.doi.org/10.1017/s1478951504040428.
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End-of-life care provides an opportunity to help a patient find meaning in the experience of dying. This is a challenge because the experience of dying can rob a patient of meaning. The first step is to look at death as being a process of life rather than an event. This is brought about by welding the broken pieces of the mind–body connection. Medicine cannot always fix broken pieces, but spiritual welding always puts us back together again. Compassionate end-of-life care helps a patient connect spirituality with the search for meaning and transcendence.
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Rowling, Louise, Zita Weber, and Lesley Scanlon. "Transitions and Loss: Illuminating Parameters of Young Adults' Mental Health." Australian Journal of Guidance and Counselling 15, no. 2 (December 1, 2005): 168–81. http://dx.doi.org/10.1375/ajgc.15.2.168.
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AbstractDifferent disciplinary groups are increasingly questioning current conceptualisations of young adults' educational, social and personal lives after compulsory schooling. New perspectives are being advanced on the life trajectories of choice and complexity now experienced by school leavers. A consistent theme is the changed nature of young adults' lives, reflecting social and economic pressures on educational, work and personal life goals. This age group has the highest incidence of mental disorders of any age cohort (Andrews, Hall, Teesson, & Henderson, 1999). The changed learning environment in the move to university entails life and environmental events that create risk conditions for young adults. In these circumstances varying degrees of loss, challenge and personal growth exist. Concurrent personal losses, such as death of a peer or family member, broken love relationships, and failure to achieve the dream of a future career, can create particular vulnerabilities. Loss may interfere with the natural progression of intellectual–emotional–psychological growing up (Kastenbaum, 2001). In this article the mental health of young adults is viewed through the lens of loss experiences within a context of change in their life trajectory. Data is drawn from a mixed method study involving questionnaire completion and in-depth interviews of students in four university campuses in New South Wales.
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Ratuiste, Kyle. "The Limits of “Actively Dying” as a Moral Concept." Ethics & Medics 43, no. 5 (2018): 1–2. http://dx.doi.org/10.5840/em20184358.
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For the term “actively dying” to contribute to ethical decision making, it must communicate morally relevant information. For instance, concerning the principle of proportionality, the phrase must indicate a physiological condition of the patient that obviates the benefits of intervention, exacerbates existing burdens, or introduces new ones. Furthermore, it must relate this information accurately and in a timely fashion. The initial challenge is that terms like “actively dying” appear to be loosely defined and equivocally employed. While many people may presume that the final phase of one’s life prior to death is distinctive and therefore distinguishable from preceding phases, people employ a variety of terms to signify what they intuitively recognize. Further complicating the matter, there is an apparent divergence in what precisely people are trying to describe.
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Croucher, Karina, Lindsey Büster, Jennifer Dayes, Laura Green, Justine Raynsford, Louise Comerford Boyes, and Christina Faull. "Archaeology and contemporary death: Using the past to provoke, challenge and engage." PLOS ONE 15, no. 12 (December 29, 2020): e0244058. http://dx.doi.org/10.1371/journal.pone.0244058.
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While death is universal, reactions to death and ways of dealing with the dead body are hugely diverse, and archaeological research reveals numerous ways of dealing with the dead through time and across the world. In this paper, findings are presented which not only demonstrate the power of archaeology to promote and aid discussion around this difficult and challenging topic, but also how our approach resulted in personal growth and professional development impacts for participants. In this interdisciplinary pilot study, archaeological case studies were used in 31 structured workshops with 187 participants from health and social care backgrounds in the UK, to explore their reactions to a diverse range of materials which documented wide and varied approaches to death and the dead. Our study supports the hypothesis that the past is a powerful instigator of conversation around challenging aspects of death, and after death care and practices: 93% of participants agreed with this. That exposure to archaeological case studies and artefacts stimulates multifaceted discourse, some of it difficult, is a theme that also emerges in our data from pre, post and follow-up questionnaires, and semi-structured interviews. The material prompted participants to reflect on their biases, expectations and norms around both treatment of the dead, and of bereavement, impacting on their values, attitudes and beliefs. Moreover, 87% of participants believed the workshop would have a personal effect through thinking differently about death and bereavement, and 57% thought it would impact on how they approached death and bereavement in their professional practice. This has huge implications today, where talk of death remains troublesome, and for some, has a near-taboo status–‘taboo’ being a theme evident in some participants’ own words. The findings have an important role to play in facilitating and normalising discussions around dying and bereavement and in equipping professionals in their work with people with advanced illness.
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Staton, David. "Beautiful Deaths and Heard Gazes." Eikon / Imago 10 (February 8, 2021): 211–20. http://dx.doi.org/10.5209/eiko.74146.
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Viewers frequently encounter “normative” prescriptions and perceptions through photographs of how images depicting death and dying should loo and, cognitively, how those images ought to be received. In such encounters, varying fundamental views or cultural myths surrounding death and dying, how it is envisioned, how it is, literally, pictured dictate a particular way of seeing and being. This article considers visual representations made of individuals who choose to enact Death With Dignity provisions to end their lives on their own terms and on their own time line. By an interrogation of a corpus of DWD images, the author investigates how such representations challenge a particular cultural logic. This reconsideration may lead to an awareness; a reasoning, creating a space in which reality is constructed beneath the viewer’s gaze. Such a reality, relies on an embodied or pragmatic aesthetic and is co-constituted by expressions of power that emanate from image and viewer. The author dubs this modality the heard gaze; a vision in which the past, present, and future are fused and subject becomes object or vessel of understanding by perceiving a visual, auditory “cue”.
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Ferrari Wanseele, Janet, and Michael Hviid Jacobsen. "’’I Did It My Way’’? – en sociologisk samtidsdiagnose over den senmoderne/postmoderne død." Dansk Sociologi 20, no. 4 (December 23, 2009): 9–34. http://dx.doi.org/10.22439/dansoc.v20i4.3135.
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I denne artikel beskrives de senere års forandringer i dele af den danske døds- og mindekultur med fokus på, hvorledes den enten adskiller sig fra eller mere skal ses som en forlængelse af den i samfundsforskningen ofte fremhævede, fortrængte og tabuiserede dødskultur fra det 20. århundrede. Gennem artiklen diskuterer og illustrerer forfatterne mange af nutidens forandringer gennem en række nedslag i form af et fokus på omsorgen for den døende, individualiseringen af institutionelle og professionelle praksisser, personliggørelsen af ritualer og ceremonier, udfordringen af traditioner og konventioner og den ændrede betydning af kirkegården og mindekulturen. Formålet med artiklen er således at beskrive og dokumentere nogle af de mest centrale ændringer i vores samfunds dødskultur som et spejlbillede på mange af de øvrige samfundsforandringer, der udspiller sig. Derudover ønsker forfatterne at anspore til debat om, hvorvidt den udbredte postmoderniseringstese om valgfrihed, fleksibilitet og individualisering inden for dødsområdet kan underbygges, eller om den skal suppleres med en senmoderniseringstese, der har fokus på institutionel kontrol og inerti.
Søgeord: Senmoderne død, postmoderne død, institutioner, ritualer, mindekultur, professionalisering.
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Janet Ferrari Wanseele and Michael Hviid Jacobsen:
”I did It My Way”? – A Sociological Contemporary Diagnosis of Late Modern/Post Modern Death
This article describes some of the major changes taking place in the contemporary culture of death, dying and bereavement in Denmark. It does so by analysing how these may be contrasted with or seen as a continuation of the often advanced thesis of a death-denying and death-taboo culture of the 20th century. The authors illustrate many of the changes through analysis of selected topics such as the care of the dying, the individualization of institutional and professional practice, the personalized content of rituals and ceremonies, the challenge to traditions and conventions and the changing mentality regarding resting place and memorial culture. The purpose of the article is to describe and document some of the major shifts in death and dying as a corollary to contemporary changes within the culture at large. In addition the authors speculate as to whether the current popularity of the thesis of a postmodernization of death and dying can be substantiated or whether it needs to be supplemented by a late modern thesis concerned with institutional control and inertia.
Key words: Late modern death, postmodern death, institutions, rituals, memorial culture, professionalization.
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Ural, Nur Yasemin. "A Genealogy of Muslims Dying in France." Sociology of Islam 2, no. 1-2 (November 21, 2014): 1–20. http://dx.doi.org/10.1163/22131418-00201006.
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The question of the death of a Muslim in France engenders a discussion on the forms and limits of secularisation in the public sphere. Contrary to other public institutions like schools, hospitals and prisons, the particularity of mortuary spaces lies in their nearly uncontested religious character, also recognised by the French state. Despite the fact that repatriation remains to be the dominant practice among French Muslims, the descending generations, who overtly declare their identities as Muslim and European at the same time, seek to obtain their place within the European public sphere. Yet accommodating deceased bodies of Muslims within the so-called secular cemeteries represents a real challenge in terms of space, recognition of religious identities and application of Islamic funerary rites. The regulations imposed by the French authorities seem to pose serious problems to Muslims, who desire to be buried in accordance with the requirements of their religion. In this respect the cemetery becomes a realm of spatio-temporal struggle, where subjectivities are formed via negotiations between the subjects—dead or alive—and state apparatuses. This article aims to reflect on the power struggles in the development of the mortuary space from a historical perspective. It will then attempt to shed light on the legal possibility of the construction of the only French Muslim cemetery inaugurated in Strasbourg in 2012.
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Turner, Suzette, Sarah Torabi, and Kalli Stilos. "Quality dying: An approach to ICD deactivation in the hospital setting." American Journal of Hospice and Palliative Medicine® 37, no. 9 (March 4, 2020): 664–68. http://dx.doi.org/10.1177/1049909120905254.
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Background: In Canada, cardiovascular disease is the second most common cause of death. A subset of these patients will require a cardiovascular implantable electronic device (CIED). An estimated 200 000 Canadians are living with a CIED. CIEDs can improve life and prevent premature death. However, when patients reach the end of their lives, they can pose a challenge. An example of which is a painful shock delivered from an implantable cardioverter defibrillator (ICD) for an arrhythmia in a dying patient. Receiving a shock at the end of life (EOL) is unacceptable in an age when we aim to ease the suffering of the dying and allow for a comfortable death. Methods: As a quality standard of practice, all clinicians are expected to engage in EOL conversations in patients requiring CIED deactivation. Due to the potential discomfort of an ICD shock, specific conversations about deactivation of an ICD are encouraged. A process improvement approach was developed by our hospital that included an advance care planning simulation lab, electronic documentation and a standardized comfort measures order set that includes addressing the need for ICD deactivation at EOL. Results: EOL conversations are complex. Health care providers have been equally challenged to have conversations about ICD deactivation. Standardization of the process of ICD deactivation ensures an approach to EOL which respects the individuality of patients and promotes quality dying. Conclusion: Our hospital is committed to assisting clinicians to provide quality care by improving conversations about EOL care. On the basis of a synthesis of existing literature, we describe the importance of and the ideal process for having EOL conversations in patients about ICD deactivation at the EOL.
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Abubakar, Mustapha Y., Jamila Lawal, Hassan Dadi, and Umaru S. Grema. "Diphtheria: a re-emerging public health challenge." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 1 (December 23, 2019): 191. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20195713.
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<p class="abstract">Diphtheria is a highly contagious, potentially life threatening bacterial infection caused by <em>Corynebacterium diphteriae. </em>Diphtheria is transmitted from person to person, usually through respiratory droplets and can lead to severe breathing problems, heart failure, blood disorders and death. Diphtheria was basically eliminated after the introduction of the vaccine in the 1940-1950s. However there is presently global concern that diphtheria is reemerging. We herein report nine cases of diphtheria presenting within a period of six months. All cases presented with sore throat, fever, membrane in the oropharynx and bull neck. Eight of the cases had never been immunized against diphtheria. All cases progressed and developed various complications with 8 of the cases dying. None of the cases had diphtheria antitoxin. This cases present the potential for this highly fatal but preventable disease reemerging and the need to be aware of epidemiological features, clinical signs and symptoms of diphtheria so that cases can be promptly diagnosed and treated, and further public health measures can be taken to contain this serious disease.</p>
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Winkler, Carol, Kareem ElDamanhoury, Aaron Dicker, and Anthony F. Lemieux. "Images of death and dying in ISIS media: A comparison of English and Arabic print publications." Media, War & Conflict 12, no. 3 (January 10, 2018): 248–62. http://dx.doi.org/10.1177/1750635217746200.
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Images of death and dying in the media around the globe have a symbiotic relationship with nation states as they can bolster state control by defining who has the right to take lives in the interests of the community, by identifying enemies of the state, by demonstrating dominance over enemies, and by lending a moral posture to the state’s war efforts. Previously, the growing corpus of research on media’s display of death and about to die images has focused almost exclusively on media outlets that bolster established states on the global stage. By analyzing 1965 death and about to die images displayed in Dabiq, ISIS’s English-language magazine, and al-Naba’, the same group’s Arabic-language newspaper, this study adds an understanding of the messaging strategies deployed by groups striving to challenge, rather than reinforce, existing national boundaries. The findings suggest that while ISIS adopts some standard media practices, it also utilizes unique and audience targeted approaches regarding the frequency of image use, the identify of the corpses, the display of dead bodies, and the presentation of those responsible for the pictured dead bodies in its media campaign.
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Livings, Ben. "A Right to Assist? Assisted Dying and the Interim Policy." Journal of Criminal Law 74, no. 1 (February 2010): 31–52. http://dx.doi.org/10.1350/jcla.2010.74.1.615.
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There are few more controversial, or emotive, debates within the criminal law than that which surrounds the topic of euthanasia, questioning as it does the fundamental role of the law in regulating the most intimate aspects of a person's life and death. The acknowledgement by the courts (notably in the cases of Diane Pretty and Debbie Purdy) that this area engages a person's rights under the European Convention on Human Rights exacerbates the urgency of the problem, and further nuances the debate as to the extent to which the autonomy of the person is impinged upon, and whether this is a function legitimately exercised by the state. In the wake of the announcement of new guidelines for prosecution in cases of assisted suicide, this article examines the state of the law regarding assisted suicide in England and Wales, and the fragile position of euthanasia within the criminal law. It will look to the various, and often rights-based, challenges to the law, and in particular a potential challenge through Article 7 of the European Convention on Human Rights.
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Meagher, David K., and Patricia Taner Leff. "In Marie's Memory: The Rights of the Child with Life-Threatening or Terminal Illness." OMEGA - Journal of Death and Dying 20, no. 3 (May 1990): 177–91. http://dx.doi.org/10.2190/0t7j-k6l9-1quq-bl12.
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This article describes the final weeks of a dying child's life and the people who cared for her. Was the suffering and isolation surrounding Marie's death as inevitable as death itself? Marie died over eight years ago. Although specific treatment issues and modalities have changed, the ethical dilemma at the core of her life remains painfully alive and continues to challenge the hospital network that services irreversibly ill children. Goals of the discussion are fourfold: 1.) to tell Marie's story as true to her experience as possible; 2.) to explore the ethical and humanistic concerns involved in Marie's life and death; 3.) to propose a model of hospital care that would encompass these concerns and, thus, have a direct impact on improving the lives of children such as Marie; and 4.) to engender thought and debate.
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Cavaye, Joyce, and Jacqueline H. Watts. "End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives." Journal of Research in Nursing 17, no. 4 (September 8, 2010): 317–26. http://dx.doi.org/10.1177/1744987110379531.
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Providing good quality care for dying patients has been highlighted as a national priority in the UK. The Department of Health’s end-of-life (EOL) care strategy outlines how patients should be cared for to ensure that they experience a ‘good death’. Nurses have an important role to play in the delivery of EOL care and need to be knowledgeable about the palliation of symptoms and the social context of death and dying. Traditionally, the pre-registration nursing curriculum has had a limited emphasis on EOL care. While there have been significant developments in nurse education in the last decade, the amount of EOL content in nurse education remains inadequate. Drawing on literature mainly from the UK and USA, this review explores from the perspectives of students, newly qualified nurses, patients and carers the outcomes of EOL education. It reviews the evidence to determine whether newly qualified nurses are adequately prepared to deliver quality care to patients at the end of their lives. The evidence suggests that despite a greater emphasis on EOL care in nurse training, adequately preparing nurses remains a challenge to educators.
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Furingsten, Lovisa, Reet Sjögren, and Maria Forsner. "Ethical challenges when caring for dying children." Nursing Ethics 22, no. 2 (June 10, 2014): 176–87. http://dx.doi.org/10.1177/0969733014533234.
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Background: Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals. Objective: The aim of this study was to describe caring as represented in healthcare workers’ experiences of caring for dying children. Method: A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence. Ethical considerations: Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved. Findings: The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice. Discussion: Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient’s needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge. Conclusion: Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying.
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GARDINER, DALE, and ROBERT SPARROW. "Not Dead Yet: Controlled Non-Heart-Beating Organ Donation, Consent, and the Dead Donor Rule." Cambridge Quarterly of Healthcare Ethics 19, no. 1 (December 22, 2009): 17–26. http://dx.doi.org/10.1017/s0963180109990211.
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The emergence of controlled, Maastricht Category III, non-heart-beating organ donation (NHBD) programs has the potential to greatly increase the supply of donor solid organs by increasing the number of potential donors. Category III donation involves unconscious and dying intensive care patients whose organs become available for transplant after life-sustaining treatments are withdrawn, usually on grounds of futility. The shortfall in organs from heart-beating organ donation (HBD) following brain death has prompted a surge of interest in NHBD. In a recent editorial, the British Medical Journal described NHBD as representing “a challenge which the medical profession has to take up.”
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Stiel, Stephanie, Maria Heckel, Kim Nikola Wendt, Martin Weber, and Christoph Ostgathe. "Palliative Care Patients’ Quality of Dying and Circumstances of Death—Comparison of Informal Caregivers’ and Health-Care Professionals’ Estimates." American Journal of Hospice and Palliative Medicine® 35, no. 7 (March 8, 2018): 1023–29. http://dx.doi.org/10.1177/1049909118756616.
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Background: Patient-reported outcomes are usually considered to be the gold standard assessment. However, for the assessment of quality of dying and death, ratings of informal caregivers (ICGs) or health-care professionals (HCPs) must be considered for ethical and methodological reasons. This article aims to present results of ICGs’ and HCPs’ estimates of the questionnaire, quality of dying and death (QoDD) on patients who died in PCUs and to compare the level of agreement of both ratings/raters. Methods: The parent validation study to this analysis assessed the ICG and HCP versions of the QoDD. Descriptive statistics are presented for each item in both versions. T tests for the estimation of differences between ICG and HCP were performed. Case-related absolute differences between estimates were analyzed regarding the extent of agreement and deviation. Results: Two hundred fifteen matched ICG and HCP ratings were analyzed. The ratings in all 6 QoDD dimensions were high; single items scored low. Mean absolute difference between both ratings was 0.33 (standard deviation [SD]: 3.08; median 0.05) on a 0 to 10 numerical rating scale and ranges between −8.24 (higher rating of ICGs compared to HCPs) and 9.33 (higher rating of HCPs compared to ICGs). Conclusions: The findings appear to show a high satisfaction with quality of dying and death as rated by ICGs and HCPs, but we suspect this might be indicative of a methodological challenge, that is, a ceiling effect in both assessments. Single low scoring items may provide important clues for improvement in end-of-life care. Although descriptive data show comparable mean values and standard deviations, the actual congruence of ratings is low. In summary, replacing one rating by another cannot be recommended.
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Koukourakis, Michael I. "Low-Dose Radiotherapy for Late-Stage COVID-19 Pneumonia?" Dose-Response 18, no. 3 (July 1, 2020): 155932582095135. http://dx.doi.org/10.1177/1559325820951357.
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Low dose radiotherapy has been used in the pre-antibiotic era for the treatment of all kind of pneumonia, with relative success. The unimaginable daily death toll of thousands of victims dying from COVID-19 pneumonia and the marginal therapeutic value of agents tested, brings forward the re-evaluation of the position of radiotherapy in the treatment of late stage lethal COVID-induced respiratory failure. A sound biological rationale supports this idea. Immunopathology studies show that excessive inflammation and infiltration of the lung parenchyma by immune cells is the cause of death. Mice lacking IFNαβ receptors remain unaffected by the virus. Radiotherapy at doses of 50-200cG may exert an intense anti-inflammatory effect and reduce the burden of inflammatory cells infiltrating the lungs. Whether radiotherapy, in conjunction with remdesivir and/or macrolides can reduce the dramatic death rates related to COVID-19 is an open challenge, under the absence of an alternative solution.
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Karlsson, Margareta, Anne Kasén, and Carola Wärnå-Furu. "Reflecting on one's own death: The existential questions that nurses face during end-of-life care." Palliative and Supportive Care 15, no. 2 (June 27, 2016): 158–67. http://dx.doi.org/10.1017/s1478951516000468.
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AbstractObjective:When registered nurses care for patients at the end of life, they are often confronted with different issues related to suffering, dying, and death whether working in hospital or community care. Serious existential questions that challenge nurses’ identities as human beings can arise as a result of these situations. The aim of our study was to describe and gain a deeper understanding of nurses’ existential questions when caring for dying patients.Method:Focus-group interviews with registered nurses who shared similar experiences and backgrounds about experiences in end-of-life care were employed to gain a deeper understanding about this sensitive subject. Focus-group interviews were performed in hospice care, in community care, and in a palliative care unit in western Sweden. A qualitative hermeneutic approach was employed to interpret the data.Results:Nurses’ existential questions balanced between responsibility and guilt in relation to their patients, between fear and courage in relation to being professional caregivers and fellow human beings, and between hope and despair in relation to the other's and their own death.Significance of results:Nurses in end-of-life care experience various emotions from patients related to things physical, spatial, and temporal. When nurses encounter these emotions as expressing a patient's suffering, they lead to challenges of balancing between different feelings in relation to patients, as both professional caregivers and fellow human beings. Nurses can experience growth both professionally and as human beings when caring for patients at the end of life.
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Anderson, Dean, and Joanna De Souza. "The importance and meaning of prayer rituals at the end of life." British Journal of Nursing 30, no. 1 (January 14, 2021): 34–39. http://dx.doi.org/10.12968/bjon.2021.30.1.34.
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Death rituals, such as the ritual of prayer, can offer cultural comfort to people who are grieving the loss of their own life or that of another. This article explores the meaning of ritual, how rituals are structured and how prayer rituals are used at the end of life from a cross-cultural perspective. Facing death can be a challenge to a person's sense of identity and their understanding of their world around them, beginning a process of spiritual suffering. Prayer rituals can help maintain a sense of control and identity during this time of crisis, offering comfort, meaning and structure. Despite varying outward appearances, prayer rituals from different cultures follow similar structures that can be deconstructed, allowing nurses to decipher their meaning and deepen the quality of care they provide to the dying person and those left behind.
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Dranseika, Vilius, and Ivars Neiders. "In defense of a pluralistic policy on the determination of death." Ethics & Bioethics 8, no. 3-4 (December 1, 2018): 179–88. http://dx.doi.org/10.2478/ebce-2018-0016.
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Abstract In his paper “The challenge of brain death for the sanctity of life ethic”, Peter Singer advocates two options for dealing with death criteria in a way that is compatible with efficient organ transplantation policy. He suggests that we should either (a) redefine death as cortical death or (b) go back to the old cardiopulmonary criterion and scrap the Dead Donor Rule. We welcome Singer’s line of argument but raise some concerns about the practicability of the two alternatives advocated by him. We propose adding a third alternative that also – as the two previous alternatives – preserves and extends the possibility of organ transplantation without using anyone without their consent. Namely, we would like to draw readers’ attention to a proposal by Robert Veatch, formulated 42 years ago in his 1976 book “Death, dying, and the biological revolution” and developed further in his later publications. Veatch argues for a conscience clause for the definition of death that would permit people to pick from a reasonable range of definitional options. This autonomy-based option, we believe, is more likely to be practicable than the two options advocated by Singer. Furthermore, we present data from a study with Lithuanian participants that suggest that there is quite pronounced variation of preferences concerning death determination.
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KURASHIMA, ANDRÉA YAMAGUCHI, MARIA DO ROSÁRIO DIAS LATORRE, SILVIA APARECIDA DE PAIVA TEIXEIRA, and BEATRIZ DE CAMARGO. "Factors associated with location of death of children with cancer in palliative care." Palliative and Supportive Care 3, no. 2 (June 2005): 115–19. http://dx.doi.org/10.1017/s1478951505050194.
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Objective:The aim of this study was to identify factors associated with location of death of patients receiving palliative care in a pediatric oncology unit.Methods:A palliative care program was developed in the pediatric department in order to provide specialized attention to the patient and family in end-of-life. The program is coordinated by a nurse, delivering a simultaneous interdisciplinary team approach with focus on identification and training of a family care provider as well as local resources supplemented by support of a social worker and the community. All 87 patients in palliative care were followed by the team. The factors associated with the location of death (home or hospital) were evaluated for the 71 patients who died prior to analysis.Results: Forty-two (59%) patients died at home. Factors significantly associated with dying at home were: male with an Odds Ratio (OR) = 3.80, 95% Confidence Interval (CI) = 1.26–11.76; public health insurance (OR) = 4.95, 95%[CI] = 1.03–26.75, low educational level of the caregiver (OR) = 11.11 95%[CI] = 1.65–94.66 and low educational level of the mother (OR) = 7.07 95%[CI] = 1.37–40.14. Gender was the only independent factor associated with location of death: a boy had a higher risk of dying at home, (OR) = 4.25, 95%[CI] = 1.37–13.21 when compared to a girl.Significance of results:In our society we are still not able to provide hospice care or home care for all children, although increasing emphasis has been placed on utilizing local resources. Even though we had increased the number of desired home deaths, it is still a challenge to meet patients and families' requests. A team approach, the recognition of the factors involved, and adequate health and community support have helped us to meet the child and family's needs.
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Hawryluck, Laura A., and William R. C. Harvey. "Analgesia, Virtue, and the Principle of Double Effect." Journal of Palliative Care 16, no. 1_suppl (October 2000): S24—S30. http://dx.doi.org/10.1177/082585970001601s06.
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The principle of double effect is widely used to permit the administration of narcotics and sedatives with the intent to palliate dying patients, even though the administration of these drugs may cause hastening of death. In recent medical literature, this principle's validity has been severely criticized, causing health care providers to fear providing good palliative care. Most of the criticisms levelled at the principle of double effect arise from misconceptions about its purpose and origins. This discussion will explore how virtue-based ethics can overcome the most important challenge to the principle of double effect's validity, that of its reliance on intention to determine whether the administration of analgesia is ethically acceptable.
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Turgeon, Benjamin, and Sylvain Meloche. "Interpreting Neonatal Lethal Phenotypes in Mouse Mutants: Insights Into Gene Function and Human Diseases." Physiological Reviews 89, no. 1 (January 2009): 1–26. http://dx.doi.org/10.1152/physrev.00040.2007.
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The mouse represents the model of choice to study the biological function of mammalian genes through mutation of its genome. However, the biggest challenge of mouse geneticists remains the phenotypic analysis of mouse mutants. A survey of mouse mutant databases reveals a surprisingly high number of gene mutations leading to neonatal death. These genetically modified mouse mutants have been instrumental in elucidating gene function and have become important models of congenital human diseases. The main complication when phenotyping mutant mice dying during the neonatal period is the large spectrum of physiological systems whose defects can challenge neonatal survival. Here, we present a comprehensive review of gene mutations leading to neonatal lethality and discuss the impact of these mutations on the major physiological processes critical to mouse newborn survival: parturition, breathing, suckling, and homeostasis. Selected examples of mouse mutants are highlighted to illustrate how the precise identification of the timing and cause of death associated with these physiological processes allows for a more profound understanding of the underlying cellular and molecular defects. This review provides a guide for the analysis of neonatal lethal phenotypes in mutant mice that will be helpful for dissecting out the function of specific genes during mouse development.
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Troitskaya, Olga, Mikhail Varlamov, Anna Nushtaeva, Vladimir Richter, and Olga Koval. "Recombinant Lactaptin Induces Immunogenic Cell Death and Creates an Antitumor Vaccination Effect in Vivo with Enhancement by an IDO Inhibitor." Molecules 25, no. 12 (June 17, 2020): 2804. http://dx.doi.org/10.3390/molecules25122804.
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Natural compounds of various origins are intensively investigated for their antitumor activity. Potential benefits of antitumor therapy can be achieved when cytotoxic agents kill cancer cells and these dying cancer cells drive adoptive immunity to the tumor. This strategy was successfully demonstrated for chemotherapeutic drugs that induce immunogenic type of cell death (ICD) with release of DAMPs (danger associated molecular patterns) and exposure of “eat me” signals. In this study, we demonstrated that recombinant human milk peptide lactaptin (RL2) induces death of cancer cells with ICD hallmarks in vitro with the release of ATP and high-mobility group box 1 protein (HMGB1) and exposure of calreticulin and HSP70 on the external cell membrane. RL2-treated cancer cells were efficiently engulfed by phagocytic cells. Using the syngeneic mouse model, we demonstrated that RL2-treated MX-7 rhabdomyosarcoma cells confer long-term immune-mediated protection against challenge with live MX-7 cells. We also analyzed the combinatorial antitumor effect of vaccination with RL2-treated cells and the inhibition of indoleamine 2,3-dioxygenase (IDO) with ethyl pyruvate. Compared to solo anti-tumor immunization with RL2-treated cells, additional chemical inhibition of IDO demonstrated better long-term antitumor responses than vaccination alone.
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Lovrecic, Barbara, Mercedes Lovrecic, Branko Gabrovec, Marco Carli, Matteo Pacini, Angelo G. I. Maremmani, and Icro Maremmani. "Non-Medical Use of Novel Synthetic Opioids: A New Challenge to Public Health." International Journal of Environmental Research and Public Health 16, no. 2 (January 9, 2019): 177. http://dx.doi.org/10.3390/ijerph16020177.
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Background: In the last decade there has been a progressive increase in the use of new psychoactive substances (NPSs) that are not yet under international control. In particular, novel synthetic opioids (NSOs) have reappeared on the recreational drug market in the last few years. As a result, the use of NSOs has increased rapidly. This poses an emerging and demanding challenge to public health. Aim: To raise awareness among clinicians and other professionals about NPSs, especially NSOs, to summarize current knowledge about pharmacological properties, forms of NSO on the market, pattern of use, effects and consequences of use. Methods: An electronic search was carried out on the Medline/PubMed and Google Scholar databases to find selected search terms. Results: Some NPSs are already controlled, while others can be legally sold directly on the drug market (mainly via internet, less so by drug dealers) or be used as precursors for the synthesis of other designer drugs that mimic the psychoactive effects of controlled substances. Potential side-effects of NSOs include miosis, sedation, respiratory depression, hypothermia, inhibition of gastrointestinal propulsion, death (from opioid overdose). Conclusions: The severity of the opioid crisis has intensified with the introduction of highly potent NSOs on the drug market. As long as addicts are dying from overdose or similar causes, there is something more constructive to do than waiting for addicts to overdose on heroin at a place located near a remedy, as if to say, within reach of naloxone.
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Laakkonen, M. L., K. H. Pitkala, and T. E. Strandberg. "Terminally Ill Elderly Patient's Experiences, Attitudes, and Needs: A Qualitative Study." OMEGA - Journal of Death and Dying 49, no. 2 (October 2004): 117–29. http://dx.doi.org/10.2190/kvm3-ulm7-0ruh-kvqh.
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The aim of this qualitative study was to clarify how terminally ill elderly patients in acute wards perceive the end of life and what are their needs and wishes regarding care. The patients, despite their advanced illness, wished to be treated actively and hoped for more conversations with doctors about active care. They were content with their daily care but evaluated the care in light of the great workload of the nurses, forgiving them for not having time to talk to individual patients. They had specific modest wishes, but were reluctant to express even these because of concern about troubling their caregivers. We conclude that death remained a distant abstraction for these patients with a terminal prognosis. The challenge is to create an intimate caring atmosphere, where the issues related to dying may be elaborated in interaction and the last wishes expressed in a safe atmosphere.
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Conant, Loring, and Arlene Lowney. "The Role of Hospice Philosophy of Care in Nonhospice Settings." Journal of Law, Medicine & Ethics 24, no. 4 (1996): 365–68. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01880.x.
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Many advances in public health and medical technology have contributed to the improved wellbeing and overall longevity of Americans. Such benefits, however, have been offset by a change in the nature and prolongation of the dying process. Daniel Callahan offers a challenge to caregivers in his observation of violent death by technological attenuation, and he sets an agenda to identify a more appropriate approach to the needs of the dying.Over the past quarter century, hospice has increasingly been used as a resource for care at the end of life. However, according to 1995 estimates by the National Hospice Organization (NHO), hospice care presently accounts for only about 15 percent of the care of terminally ill patients in the United States. We will review issues of access and use of hospice services and examine the various institutional, professional, societal, and cultural barriers to hospice principles of care, and consider various options to promote optimal care at the end of life.
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Norton, Loretta, Raechelle M. Gibson, Teneille Gofton, Carolyn Benson, Sonny Dhanani, Sam D. Shemie, Laura Hornby, Roxanne Ward, and G. Bryan Young. "Electroencephalographic Recordings During Withdrawal of Life-Sustaining Therapy Until 30 Minutes After Declaration of Death." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 2 (October 28, 2016): 139–45. http://dx.doi.org/10.1017/cjn.2016.309.
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AbstractBackground: The timing of the circulatory determination of death for organ donation presents a medical and ethical challenge. Concerns have been raised about the timing of electrocerebral inactivity in relation to the cessation of circulatory function in organ donation after cardio-circulatory death. Nonprocessed electroencephalographic (EEG) measures have not been characterized and may provide insight into neurological function during this process. Methods: We assessed electrocortical data in relation to cardiac function after withdrawal of life-sustaining therapy and in the postmortem period after cardiac arrest for four patients in a Canadian intensive care unit. Subhairline EEG and cardio-circulatory monitoring including electrocardiogram, arterial blood pressure (ABP), and oxygen saturation were captured. Results: Electrocerebral inactivity preceded the cessation of the cardiac rhythm and ABP in three patients. In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and ABP. There was a significant difference in EEG amplitude between the 30-minute period before and the 5-minute period following ABP cessation for the group, but we did not observe any well-defined EEG states following the early cardiac arrest period. Conclusions: In a case series of four patients, EEG inactivity preceded electrocardiogram and ABP inactivity during the dying process in three patients. Further study of the electroencephalogram during the withdrawal of life sustaining therapies will add clarity to medical, ethical, and legal concerns for donation after circulatory determined death.
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Breidthardt, Tobias, Griet Vanpoucke, Mihael Potocki, Tamina Mosimann, Ronny Ziller, Gregoire Thomas, Wouter Laroy, et al. "The novel marker LTBP2 predicts all-cause and pulmonary death in patients with acute dyspnoea." Clinical Science 123, no. 9 (July 13, 2012): 557–66. http://dx.doi.org/10.1042/cs20120058.
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The risk stratification in patients presenting with acute dyspnoea remains a challenge. We therefore conducted a prospective, observational cohort study enrolling 292 patients presenting to the emergency department with acute dyspnoea. A proteomic approach for antibody-free targeted protein quantification based on high-end MS was used to measure LTBP2 [latent TGF (transforming growth factor)-binding protein 2] levels. Final diagnosis and death during follow-up were adjudicated blinded to LTBP2 levels. AHF (acute heart failure) was the final diagnosis in 54% of patients. In both AHF (P<0.001) and non-AHF (P=0.015) patients, LTBP2 levels at presentation were significantly higher in non-survivors compared with survivors with differences on median levels being 2.2- and 1.5-fold respectively. When assessing the cause of death, LTBP2 levels were significantly higher in patients dying from pulmonary causes (P=0.0005). Overall, LTBP2 powerfully predicted early pulmonary death {AUC (area under the curve), 0.95 [95% CI (confidence interval), 0.91–0.98]}. In ROC (receiver operating characteristic) curve analyses for the prediction of 1-year mortality LTBP2 achieved an AUC of 0.77 (95% CI, 0.71–0.84); comparable with the predictive potential of NT-proBNP [N-terminal pro-B-type natriuruetic peptide; 0.77 (95% CI, 0.72–0.82)]. Importantly, the predictive potential of LTBP2 persisted in patients with AHF as the cause of dypnea (AUC 0.78) and was independent of renal dysfunction (AUC 0.77). In a multivariate Cox regression analysis, LTBP2 was the strongest independent predictor of death [HR (hazard ratio), 3.76 (95% CI, 2.13–6.64); P<0.0001]. In conclusion, plasma levels of LTBP2 present a novel and powerful predictor of all-cause mortality, and particularly pulmonary death. Cause-specific prediction of death would enable targeted prevention, e.g. with pre-emptive antibiotic therapy.
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Hilden, Joanne M., Ezekiel J. Emanuel, Diane L. Fairclough, Michael P. Link, Kathleen M. Foley, Brian C. Clarridge, Lowell E. Schnipper, and Robert J. Mayer. "Attitudes and Practices Among Pediatric Oncologists Regarding End-of-Life Care: Results of the 1998 American Society of Clinical Oncology Survey." Journal of Clinical Oncology 19, no. 1 (January 1, 2001): 205–12. http://dx.doi.org/10.1200/jco.2001.19.1.205.
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PURPOSE: In 1998, the American Society of Clinical Oncology (ASCO) surveyed its membership to assess the attitudes, practices, and challenges associated with end-of-life care of patients with cancer. In this report, we summarize the responses of pediatric oncologists and the implications for care of children dying from cancer. METHODS: The survey consisted of 118 questions, covering eight categories. All ASCO members in the United States, Canada, and the United Kingdom were mailed a survey, which was completed by 228 pediatric oncologists. Predictors of particular attitudes and practices were identified using stepwise logistic regression analysis. Potential predictors were age, sex, religious affiliation, importance of religious beliefs, recent death of a relative, specialty, type of practice (rural or urban, academic or nonacademic), amount of time spent in patient care, number of new patients in the past 6 months, and number of patients who died in the past year. RESULTS: Pediatric oncologists reported a lack of formal courses in pediatric palliative care, a strikingly high reliance on trial and error in learning to care for dying children, and a need for strong role models in this area. The lack of an accessible palliative care team or pain service was often identified as a barrier to good care. Communication difficulties exist between parents and oncologists, especially regarding the shift to end-of-life care and adequate pain control. CONCLUSION: Pediatric oncologists are working to integrate symptom control, psychosocial support, and palliative care into the routine care of the seriously ill child, although barriers exist that make such comprehensive care a challenge.