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Journal articles on the topic 'Social aspects of Terminally ill'

Author: Grafiati

Published: 4 June 2021

Last updated: 12 February 2022

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1

Jansen, Lynn A., Steven Wall, and Franklin G. Miller. "Drawing the line on physician-assisted death." Journal of Medical Ethics 45, no. 3 (November 21, 2018): 190–97. http://dx.doi.org/10.1136/medethics-2018-105003.

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Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.

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2

Tang, Yong. "Challenges, personal growth and social support among family caregivers of terminally ill cancer patients in Southern China." Qualitative Social Work 18, no. 4 (February 2, 2018): 638–54. http://dx.doi.org/10.1177/1473325018755890.

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The purpose of this study was to obtain a deeper understanding of the experiences of family caregivers of terminally ill cancer patients in Shenzhen, Southern China. This study sought to describe how being the main caregiver influences family caregivers’ daily lives. This article reports on the findings from individual interviews with 20 family caregivers of terminally ill cancer patients. The interview transcripts were analyzed using qualitative thematic analysis, which revealed that caring for a cancer patient over the course of his or her illness significantly affected many aspects of family caregivers’ lives. Three major themes were identified in their experiences: (1) challenges, (2) personal growth, and (3) social support. In exploring these themes, this article offers insights into family caregivers’ experiences in Southern China, particularly among family members of terminally ill cancer patients and presents implications for future professional practice, especially oncology social work.

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3

Tulsky, James A., Ann Alpers, and Bernard Lo. "A Middle Ground on Physician-Assisted Suicide." Cambridge Quarterly of Healthcare Ethics 5, no. 1 (1996): 33–43. http://dx.doi.org/10.1017/s0963180100006708.

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“[A] murder prosecution is a poor way to design an ethical and moral code for doctors,” observed the California Court of Appeal in 1983. Yet, physicians who have chosen to help terminally ill patients to commit suicide have trespassed on illegal ground. When skilled medical care fails to relieve the pain of terminally ill patients, some people believe that physicians may assist in these suicides. Others reject any kind of physician involvement. The debate on assisted suiczide and active euthanasia has focused on whether these acts can ever be acceptable. We propose to shift the debate to a less divisive issue: whether a caring physician who provides a suffering and ill patient with a prescription for a lethal dose of medication should be prosecuted as a felon. Even assisted suicide's opponents may object to such criminal prosecution. We propose to modify existing criminal laws to give physicians who assist their terminally ill patients in suicide, under carefully defined circumstances, a legal defense against criminal charges.

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4

Keeling, Geoff. "The sensitivity argument against child euthanasia." Journal of Medical Ethics 44, no. 2 (April 5, 2017): 143–44. http://dx.doi.org/10.1136/medethics-2017-104221.

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Is there a moral difference between euthanasia for terminally ill adults and euthanasia for terminally ill children? Luc Bovens considers five arguments to this effect, and argues that each is unsuccessful. In this paper, I argue that Bovens' dismissal of the sensitivity argument is unconvincing.

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5

Stone, P., and C. Phillips. "Nutrition, dehydration and the terminally ill." Journal of Medical Ethics 21, no. 1 (February 1, 1995): 55. http://dx.doi.org/10.1136/jme.21.1.55.

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6

Craig, G. M. "Nutrition, dehydration and the terminally ill." Journal of Medical Ethics 21, no. 3 (June 1, 1995): 184–85. http://dx.doi.org/10.1136/jme.21.3.184.

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7

Koch, Tom, Martin Gunderson, and David Mayo. "Physician-Assisted Death for the Terminally Ill." Hastings Center Report 31, no. 3 (May 2001): 4. http://dx.doi.org/10.2307/3527542.

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8

Konishi, Emiko, Anne J Davis, and Toshiaki Aiba. "The Ethics of Withdrawing Artificial Food and Fluid from Terminally Ill Patients: an end-of-life dilemma for Japanese nurses and families." Nursing Ethics 9, no. 1 (January 2002): 7–19. http://dx.doi.org/10.1191/0969733002ne477oa.

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End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: if the patient requested it, and if it relieved the patient’s suffering. They considered that the doctor’s orders, the family’s request, or the patient’s advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed.

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9

Heras, P., K. Kritikos, A. Georgopoulou, A. Hatzopoulos, and N. Kritikos. "Spirituality and religion in terminally ill patients with cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 19587. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.19587.

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19587 Background: The importance of spirituality and religion in coping with a terminal illness is becoming increasingly recognised. We aimed to assess the relation between spiritual well-being, religiosity, depression, and end-of-life despair in terminally-ill cancer patients. Methods: One hundred forty three terminally ill cancer patients with a life expectancy of less than 6 months were interviewed with a series of standardised instruments, including the FACIT Spiritual Well-Being Scale, a religiosity index similar to those used in previous research, the Hamilton depression rating scale, the Memorial Symptom Assessment Scale and the Duke-UNC Functional Social Support Questionnaire. Results: A strong negative association was observed between the FACIT Spiritual Well-Being scale and the HDRS, but no such relationship was found for religiosity. Similar patterns were observed for the FACIT subscales, finding a strong negative association between the meaning and peace subscale (which corresponds to the more existential aspects of spirituality) and HDRS scores, whereas a positive, albeit nonsignificant, association was observed for the faith subscale (which corresponds more closely to religiosity). Conclusions: These results suggest that the beneficial aspects of religion may be primarily those that relate to spiritual well-being rather than to religious practices per se. Spiritual well-being offers some protection against end-of-life despair in those for whom death is imminent. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among terminally ill patients with cancer. No significant financial relationships to disclose.

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10

HUANG, HAI SHAN, TIE YING ZENG, JING MAO, and XIAO HONG LIU. "The Understanding of Death in Terminally Ill Cancer Patients in China: An Initial Study." Cambridge Quarterly of Healthcare Ethics 27, no. 3 (May 30, 2018): 421–30. http://dx.doi.org/10.1017/s0963180117000809.

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Abstract:Patient’s needs and rights are the key to delivering state-of-the-art modern nursing care. It is especially challenging to provide proper nursing care for patients who are reaching the end of life (EOL). In Chinese culture nursing practice, the perception and expectations of these EOL patients are not well known. This article explores the feelings and wishes of 16 terminally ill Chinese cancer patients who are going through the dying process. An open-ended questionnaire with eight items was used to interview 16 terminally ill Chinese cancer patients, and was then analyzed by a combined approach employing grounded theory and interpretive phenomenological analysis. Four dimensions were explored: first, patient’s attitudes towards death, such as accepting the fact calmly, striving to survive, and the desire for control; second, the care desired during the dying process, including avoiding excessive treatment and dying with dignity; third, the degree of the patient’s acceptance of death; and fourth, the consequences of death. This cognitive study offers a fundamental understanding of perceptions of death of terminally ill cancer patients from the Chinese culture. Their attitude toward death was complex. They did not prefer aggressive treatment and most of them had given a great deal of thought to their death.

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11

Rokach, Ami. "Loneliness in Cancer and Multiple Sclerosis Patients." Psychological Reports 94, no. 2 (April 2004): 637–48. http://dx.doi.org/10.2466/pr0.94.2.637-648.

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Loneliness is a universal social phenomenon often producing debilitating effects on many aspects of human functioning. The present study compared the qualitative aspects of loneliness in two terminally ill samples to that of a more healthy sample. 329 multiple sclerosis and 315 cancer patients, as well as 391 nonrandom healthy participants answered a 30-item questionnaire on loneliness. Analysis indicated the experience of loneliness which characterizes multiple sclerosis and cancer patients differs from that of the more healthy group.

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12

Gunderson, Martin, and David J. Mayo. "Restricting Physician-Assisted Death to the Terminally Ill." Hastings Center Report 30, no. 6 (November 2000): 17. http://dx.doi.org/10.2307/3528448.

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13

De Ridder, Dolf, and Chris Gastmans. "Dehydration Among Terminally Ill Patients: an Integrated Ethical and Practical Approach for Caregivers." Nursing Ethics 3, no. 4 (December 1996): 305–16. http://dx.doi.org/10.1177/096973309600300404.

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The purpose of this paper is to examine the possibilities and limitations of an ethical and practical approach to terminal dehydration. We have argued that dehydration among terminally ill patients offers an important key to a better understanding of the dying process, and that the caregivers' reactions can lead to a deepening of holistic palliative care. This article makes clear that the moral question of terminal dehydration can only be treated by an interdisciplinary approach. Therefore, before studying the question of the most humane course possible, we must first understand the meaning of dehydration and its repercussions for the dying patient. Inspired by an attitude of respect for a good dying process, we have suggested that it is possible to put forward as a general guideline that medical therapy should be progressively reduced when it has been determined that a patient has reached the terminal stage, or is in an irreversible deteriorating process. We describe the critical somatic, social, psychological, moral and spiritual points, which make up an ethical approach to terminal dehydration (TD). In the total care of the irreversibly terminally ill patient, tolerating TD can be an expression of an authentic and caring involvement in the dying patient's welfare.

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14

Weisleder, P. "Physicians as healthcare surrogate for terminally ill children." Journal of Medical Ethics 34, no. 9 (September 1, 2008): e8-e8. http://dx.doi.org/10.1136/jme.2007.023051.

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15

Fraser, S. I. "Death - whose decision? Euthanasia and the terminally ill." Journal of Medical Ethics 26, no. 2 (April 1, 2000): 121–25. http://dx.doi.org/10.1136/jme.26.2.121.

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16

Schwartz, Robert L. "Rights of the Terminally Ill Act of the Australian Northern Territory." Cambridge Quarterly of Healthcare Ethics 5, no. 1 (1996): 157–66. http://dx.doi.org/10.1017/s0963180100006848.

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Over the past year the debate over physician-assisted death has been waged in several courts and legislatures, and before at least one electorate as well. Measure 16, the Oregon Death With Dignity initiative that would permit physician-assisted suicide in some circumstances, was approved by the electorate; but it remains on hold while a permanent injunction issued against it by a Federal judge is reviewed by the United States Court of Appeals. Another Federal court judge's decision that the Washington statute criminalizing physician-assisted suicide was unconstitutional when applied to the case of a competent terminally ill patient in intractable pain, was reversed by a three judge panel of that same United States Court of Appeals.

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17

Osuna, E., M. D. Perez-Carceles, M. A. Esteban, and A. Luna. "The right to information for the terminally ill patient." Journal of Medical Ethics 24, no. 2 (April 1, 1998): 106–9. http://dx.doi.org/10.1136/jme.24.2.106.

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18

BECA, JUAN PABLO, EDUARDO ROSSELOT, RENÉ ASENJO, VERÓNICA ANGUITA, and RAFAEL QUEVEDO. "Deactivating Cardiac Pacemakers and Implantable Cardioverter Defibrillators in Terminally Ill Patients." Cambridge Quarterly of Healthcare Ethics 18, no. 3 (July 2009): 236–40. http://dx.doi.org/10.1017/s0963180109090380.

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A 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker (CPM) implanted, regulated to go off at frequencies of below 70 beats per minute. Given the patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a coma.

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19

Canick, Simon M. "Constitutional Aspects of Physician-Assisted Suicide After Lee v. Oregon." American Journal of Law & Medicine 23, no. 1 (1997): 69–96. http://dx.doi.org/10.1017/s0098858800010613.

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Dying is personal. And it is profound. For many, the thought of an ignoble end, steeped in decay, is abhorrent. A quiet, proud death, bodily integrity intact, is a matter of extreme consequence.—Justice William BrennanTwo recent circuit court decisions have reinvigorated the debate over the constitutional, practical and ethical ramifications of physician-assisted suicide. In Compassion in Dying v. Washington, the Ninth Circuit Court of Appeals held that a liberty interest exists in choosing the time and manner of one’s death. The court found this right to outweigh all asserted state interests, and concluded that, with respect to competent, terminally ill adults, Washington’s prohibition of assisted suicide violates the Due Process Clause of the U.S. Constitution. The ruling effectively strikes down laws against assisted suicide in all of the states in the Ninth Circuit.In April 1996, in Quill v. Vacco, the Second Circuit Court of Appeals held that New York’s prohibition of assisted suicide violates the U.S. Constitution’s Equal Protection Clause.

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20

Barilan, Y. M. "Is the clock ticking for terminally ill patients in Israel? Preliminary comment on a proposal for a bill of rights for the terminally ill." Journal of Medical Ethics 30, no. 4 (August 1, 2004): 353–57. http://dx.doi.org/10.1136/jme.2002.000885.

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21

Halabi, Sam. "Selling Hospice." Journal of Law, Medicine & Ethics 42, no. 4 (2014): 442–54. http://dx.doi.org/10.1111/jlme.12167.

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Hospice care in the United States has undergone a remarkable transformation since it assumed its modern form in the late 1960s. It began as a movement driven by small organizations staffed with many volunteer providers focusing on comprehensive spiritual, palliative, and mental health services for a relatively small number of terminally ill patients, typically suffering from cancer. The idea behind hospice during its early days was that a terminally patient and his or her family made a decision to focus on easing a patient’s pain and anxiety, making him or her more comfortable, rather than pursuing additional curative treatment. Because these objectives required a wide range of professional and non-professional skills, hospice care involved not only physicians and nurses, but clergy, social workers, volunteer caretakers, homemakers, and, of course, family members. The process of decision-making by the patient and his or her family was never uniform and never systematically studied.

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22

Gómez-Batiste, Xavier, Montse Buisan, M. Pau González, David Velasco, Verónica de Pascual, Jose Espinosa, Anna Novellas, et al. "The “La Caixa” Foundation and WHO Collaborating Center Spanish National Program for enhancing psychosocial and spiritual palliative care for patients with advanced diseases, and their families: Preliminary findings." Palliative and Supportive Care 9, no. 3 (August 15, 2011): 239–49. http://dx.doi.org/10.1017/s1478951511000198.

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AbstractObjective:The psycho-social needs of patients with advanced chronic illness and their families include emotional, spiritual, and bereavement care. With a funding initiative by the La Caixa Foundation and design by the WHO Collaborating Center, we developed and implemented a program for the comprehensive care of terminally-ill individuals and their families, in Spain. The intent was to improve the psycho-social and spiritual dimensions of care, to generate experience and evidence, to explore models, and to act as catalyst in the Spanish National Strategy for Palliative Care.Method:We reviewed the process of design, implementation, and initial evaluation of the program at 18 months.Results:Thirty psycho-social teams’ (PST) acting as support teams projects were initiated. There were 120 full-time healthcare professionals appointed (58% clinical psychologists). These professionals received training through a comprehensive postgraduate course, and all used the same documentation. Some results were collated 18 months post-implementation. The total number of patients attended to was 10,954, and the number of relatives was 17,715. The preliminary clinical outcomes show a significant improvement in well-being, and a decrease in anxiety and insomnia, although there was a smaller impact on alleviating depression. Healthcare professionals collated results on satisfaction with palliative care (PC) services.Significance of results:Based on these preliminary results, we suggest that the PST can be a model of organization that is effective and efficient in improving the psycho-social and spiritual aspects of care of terminally ill patients. Further follow-up and evaluation with validated tools are the main goals for the immediate future.

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Lascaratos, J., E. Poulakou-Rebelakou, and S. Marketos. "Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?" Journal of Medical Ethics 25, no. 3 (June 1, 1999): 254–58. http://dx.doi.org/10.1136/jme.25.3.254.

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Horn, Ruth. "The ‘French exception’: the right to continuous deep sedation at the end of life." Journal of Medical Ethics 44, no. 3 (October 22, 2017): 204–5. http://dx.doi.org/10.1136/medethics-2017-104484.

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In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the ‘French response’ to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context.

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Hayslip, Bert, Heather L. Servaty, Toni Christman, and Elaine Mumy. "Levels of Death Anxiety in Terminally Ill Persons: A Cross Validation and Extension." OMEGA - Journal of Death and Dying 34, no. 3 (January 1, 1996): 203–17. http://dx.doi.org/10.2190/0aw5-pc4l-b6v8-dp6r.

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In order to explore the viability of the distinction between overt and covert levels of death fear, 141 individuals (32 HIV positive who had full-blown AIDS, 39 HIV positive without full-blown AIDS, 70 age-matched controls) were administered measures of conscious and unconscious death anxiety as well as a variety of self-report scales assessing life satisfaction, well-being, regrets about one's life, and hopelessness. While results suggested minimal differences to exist between the above groups for measures of conscious death fear, there were substantive, though in some respects, unanticipated differences across groups in aspects of covert fear tapping concerns about the interruption of goals and achievements, isolation from others, and pain, disease, and suffering. Results also suggested that there were both adjustment-related advantages and disadvantages associated with the appearance of symptoms signaling the appearance of full-blown AIDS. Neither gender nor the duration of time one had been living with the diagnosis of either HIV disease or AIDS influenced death fear.

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Krishna, Lalit. "Nasogastric feeding at the end of life: A virtue ethics approach." Nursing Ethics 18, no. 4 (June 3, 2011): 485–94. http://dx.doi.org/10.1177/0969733011403557.

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The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family.

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APPEL, JACOB. "When Any Answer Is a Good Answer: A Mandated-Choice Model for Advance Directives." Cambridge Quarterly of Healthcare Ethics 19, no. 3 (May 28, 2010): 417–21. http://dx.doi.org/10.1017/s0963180110000253.

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Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, billed at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts.

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Craig, G. M. "On withholding artificial hydration and nutrition from terminally ill sedated patients. The debate continues." Journal of Medical Ethics 22, no. 3 (June 1, 1996): 147–53. http://dx.doi.org/10.1136/jme.22.3.147.

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Macconville, Una, and Regina McQuillan. "A Figurational Approach: Views of Communication and Awareness of Death and Dying in Ireland." Irish Journal of Sociology 17, no. 2 (November 2009): 41–55. http://dx.doi.org/10.7227/ijs.17.2.4.

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Open awareness and communication in death and dying have become important aspects in caring for people who are terminally ill. This change began in the 1960s and has been driven by social and ideological factors, especially in highly individualistic societies such as the US and the UK. While this is the preferred interaction within palliative care, open awareness and communication about death and dying can be resisted in some societies where families seek to protect their relative from the truth of a terminal illness. This article considers some attitudes to open awareness and communication in Ireland from recent research and a popular radio talk programme. This suggests that while there is openness about issues of mortality in Ireland, there can be resistance when terminal illness becomes a reality within a family. Elias's figurational approach is utilised to understand these differing responses.

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Gillon, R. "Palliative care ethics: non-provision of artificial nutrition and hydration to terminally ill sedated patients." Journal of Medical Ethics 20, no. 3 (September 1, 1994): 131–87. http://dx.doi.org/10.1136/jme.20.3.131.

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Craig, G. M. "On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?" Journal of Medical Ethics 20, no. 3 (September 1, 1994): 139–45. http://dx.doi.org/10.1136/jme.20.3.139.

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Huang, C.-H., W.-Y. Hu, T.-Y. Chiu, and C.-Y. Chen. "The practicalities of terminally ill patients signing their own DNR orders--a study in Taiwan." Journal of Medical Ethics 34, no. 5 (May 1, 2008): 336–40. http://dx.doi.org/10.1136/jme.2007.020735.

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Brits, L., L. Human, L. Pieterse, P. Sonnekus, and G. Joubert. "Opinions of private medical practitioners in Bloemfontein, South Africa, regarding euthanasia of terminally ill patients." Journal of Medical Ethics 35, no. 3 (March 1, 2009): 180–82. http://dx.doi.org/10.1136/jme.2008.027417.

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34

RICH, BEN A. "Pathologizing Suffering and the Pursuit of a Peaceful Death." Cambridge Quarterly of Healthcare Ethics 23, no. 4 (July 17, 2014): 403–16. http://dx.doi.org/10.1017/s0963180114000085.

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Abstract:The specialty of psychiatry has a long-standing, virtually monolithic view that a desire to die, even a desire for a hastened death among the terminally ill, is a manifestation of mental illness. Recently, psychiatry has made significant inroads into hospice and palliative care, and in doing so brings with it the conviction that dying patients who seek to end their suffering by asserting control over the time and manner of their inevitable death should be provided with psychotherapeutic measures rather than having their expressed wishes respected as though their desire for an earlier death were the rational choice of someone with decisional capacity. This article reviews and critiques this approach from the perspective of recent clinical data indicating that patients who secure and utilize a lethal prescription are generally exercising an autonomous choice unencumbered by clinical depression or other forms of incapacitating mental illness.

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35

Legemaate, Johan, and J. K. M. Gevers. "Physician-Assisted Suicide in Psychiatry: Developments in the Netherlands." Cambridge Quarterly of Healthcare Ethics 6, no. 2 (1997): 175–88. http://dx.doi.org/10.1017/s0963180100007799.

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For more than two decades euthanasia and assisted suicide have been openly debated in the Netherlands. This development started in 1973 when the Regional Court in Leeuwarden decided a case in which a physician had administered a deadly dose of morphine to her terminally ill mother on the mother's serious and persistent request. In this case the court concluded that the average Dutch physician no longer considered it his or her duty to prolong a patient's life under all circumstances. The court accepted that in specific cases a physician is allowed to prevent serious and irreversible suffering, even if the patient's life is short ened. This case was the first in which a legal opening for euthanasia or assisted suicide was created. In this specific case the physician was formally declared guilty, but the court gave her a suspended sentence of one week imprisonment. This decision started a debate on euthanasia and assisted suicide throughout all levels of Dutch society.

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Barilan, Y. Michael. "The Israeli Bioethical discourse and the Steinberg Report Regarding a proposed Bill of Rights of the Terminally Ill." Ethik in der Medizin 15, no. 1 (January 30, 2003): 59–62. http://dx.doi.org/10.1007/s00481-002-0212-3.

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Wilkes, E. "On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A commentary." Journal of Medical Ethics 20, no. 3 (September 1, 1994): 144–45. http://dx.doi.org/10.1136/jme.20.3.144.

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Laurie, G. T. "Editorial comment on Y M Barilan's 'Is the clock ticking for the terminally ill patients in Israel?'." Journal of Medical Ethics 30, no. 4 (August 1, 2004): 358. http://dx.doi.org/10.1136/jme.2003.003665.

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Dunlop, R. J., J. E. Ellershaw, M. J. Baines, N. Sykes, and C. M. Saunders. "On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply." Journal of Medical Ethics 21, no. 3 (June 1, 1995): 141–43. http://dx.doi.org/10.1136/jme.21.3.141.

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Harrison, A., A. M. al-Saadi, A. S. al-Kaabi, M. R. al-Kaabi, S. S. al-Bedwawi, S. O. al-Kaabi, and S. B. al-Neaimi. "Should doctors inform terminally ill patients? The opinions of nationals and doctors in the United Arab Emirates." Journal of Medical Ethics 23, no. 2 (April 1, 1997): 101–7. http://dx.doi.org/10.1136/jme.23.2.101.

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Kuuppelomäki, Merja. "The Decision-Making Process when Starting Terminal Care as Assessed by Nursing Staff." Nursing Ethics 9, no. 1 (January 2002): 20–35. http://dx.doi.org/10.1191/0969733002ne478oa.

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This article deals with making decisions about starting terminal care. The results are part of a larger survey on nurses’ conceptions of terminal care in community health centres in Finland. The importance, frequency and timing of decision making as well as communication and the number of investigations and procedures carried out are examined. The relationship between decision making and the size of a health centre’s catchment population is also discussed. The results make it possible to compare the current situation in Finland with the national law on patients’ rights. The sample consisted of 328 nurses who worked on the wards of 32 community health centres. The data were collected by means of a structured questionnaire and processed with the Statistical Package for Social Sciences software. The nurses agreed that explicit decision making and documentation about starting terminal care were necessary, but it was highlighted that the practice had many shortcomings. Decisions were often made too late and the patients were not always aware of their situation; family members and the nursing staff were mostly better informed. It was noted that many investigations and other procedures were carried out on terminally ill patients, often at the request of family members. Decision making was found to have some relationship to the size of a health centre’s catchment area.

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GLANNON, WALTER. "The Value and Disvalue of Consciousness." Cambridge Quarterly of Healthcare Ethics 25, no. 4 (September 16, 2016): 600–612. http://dx.doi.org/10.1017/s0963180116000335.

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Abstract:Consciousness defines us as persons. It allows us to have both pleasurable and painful experiences. I present four neurological conditions in the clinical setting to explore how consciousness can be beneficial or harmful to patients: intraoperative awareness, prolonged disorders of consciousness, locked-in syndrome, and the effects of narcotics and sedation on terminally ill patients. The ethical significance of consciousness for patients in these conditions depends on two factors: the content of one’s experience and whether one can report this content to others. I argue that the value or disvalue of phenomenal consciousness, what it is like to be aware, may depend on its relation to access consciousness, the ability to report or communicate the content of awareness. Phenomenal consciousness can have disvalue when one wants or expects to be unconscious. It can also have disvalue in the absence of access consciousness because it can allow the patient to experience pain and suffer. Technology that enabled neurologically compromised patients to reliably communicate their experience and wishes could benefit and prevent harm to them. More generally, the neurological conditions I discuss raise the question of when and in what respects consciousness is preferable to unconsciousness.

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Chahal, M. "Off-trial access to experimental cancer agents for the terminally ill: balancing the needs of individuals and society." Journal of Medical Ethics 36, no. 6 (May 28, 2010): 367–70. http://dx.doi.org/10.1136/jme.2009.032466.

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Matsushima, Tatsuko, Akira Akabayashi, Brian Taylor Slingsby, and Kenji Nishitateno. "Evaluation of a program to celebrate seasonal events for Japanese hospice patients." Palliative and Supportive Care 5, no. 3 (September 2007): 251–54. http://dx.doi.org/10.1017/s1478951507000417.

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Objective: Palliative care of the terminally ill requires not only treatment of physical pain, but also care for a patient's spiritual and social needs. In Japan, where many customs correlate closely with the seasons of fall, winter, spring, and summer, seasonal events carry significance for patients who have reached a terminal stage of disease. This study determined how Japanese hospice patients evaluate a program that celebrates seasonal events and considers the modality and significance of season events at hospices.Methods: A questionnaire survey was conducted for 1 year between August 2000 and July 2001 at a hospice located in the suburbs of Tokyo, Japan. Of the original 48 instruments, a total of 43 instruments were returned (response rate: 89.6%).Results: Results showed that 72.1% of respondents participated in seasonal events, and the majority of participants positively evaluated their experiences of seasonal events. Positive aspects included being able to get a feeling for the seasons (74.2%) and being able to interact with staff and volunteers (51.6%). Negative aspects included that the events were too long (9.7%) and tiring (6.5%), and that the events made one feel sad (6.5%). Reasons for participating in seasonal events included seeming fun (71.0%), recreative (58.1%), and being entertaining (48.4%).Significance of results: Overall findings suggest that there is significance in celebrating the seasons with a monthly event at hospices. Further research is needed on the modality and experiences of celebrating the seasons at hospices in other nations.

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Rosin, A. J., and M. Sonnenblick. "Autonomy and paternalism in geriatric medicine. The Jewish ethical approach to issues of feeding terminally ill patients, and to cardiopulmonary resuscitation." Journal of Medical Ethics 24, no. 1 (February 1, 1998): 44–48. http://dx.doi.org/10.1136/jme.24.1.44.

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Russell, Cathriona. "Care, Coercion and Dignity at the End of Life." Studies in Christian Ethics 32, no. 1 (October 25, 2018): 36–45. http://dx.doi.org/10.1177/0953946818807463.

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End-of-life debates in medical ethics often centre around several interrelated issues: improving care, avoiding coercion, and recognising the dignity and rights of the terminally ill. Care ethics advocates relational autonomy and non-abandonment. These commitments, however, face system pressures—economic, social and legal—that can be coercive. This article takes up two related aspects in this domain of ethics. Firstly, that competence and communication are core clinical ethics principles that can sidestep the overplayed dichotomies in end-of-life care. And secondly, it questions the assumption that advance directives are universally benevolent—comparing the provisions of the Council of Europe’s 1999 recommendations on protection of human rights and dignity of the dying within the framework of the Irish context. The article also registers the unintended impacts of changing legal frameworks in relation to euthanasia and assisted suicide in Europe, including recent proposals in the Netherlands. A focus on human dignity can provide a theologically and philosophically shared normative orientation that argues for present directives rather than only advance directives, and a presumption in favour of ‘living up to death’. Dignity approaches not only grant rights but secure them by supporting ongoing initiatives that honour, rather than erode, the ‘longevity dividend’.

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Fernández-Sola, Cayetano, María Mar Díaz Cortés, José Manuel Hernández-Padilla, Cayetano José Aranda Torres, José María Muñoz Terrón, and José Granero-Molina. "Defining dignity in end-of-life care in the emergency department." Nursing Ethics 24, no. 1 (August 3, 2016): 20–32. http://dx.doi.org/10.1177/0969733015604685.

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Background: Respecting dignity is having a profound effect on the clinical relationship and the care framework for terminally ill patients in palliative care units, hospices and their own homes, with particular consequences for the emergency department. However, dignity is a vague and multifaceted concept that is difficult to measure. Objective: The aim of this study is to define the attributes of dignity in end-of-life care in the emergency department, based on the opinions of physicians and nurses. Research design: A hermeneutic phenomenological approach utilising Gadamer's philosophical underpinnings guided the study. Participants and research context: This research was conducted in Spain in 2013–2014. Participants included 10 physicians and 16 nurses with experience working in the emergency department. Two focus groups and 12 in-depth interviews were carried out. Ethical considerations: The study was approved by the Research Centre Ethical Committee (Andalusian Health Service, Spain). Findings: The results point to the person's inherent value, socio-environmental conditions and conscious actions/attitudes as attributes of dignity when caring for a dying patient in the emergency department. Discussion: Dying with dignity is a basic objective in end-of-life care and is an ambiguous but relevant concept for physicians and nurses. In line with our theoretical framework, our results highlight care environment, professional actions and socio-family context as attributes of dignity. Conclusion: Quality care in the emergency department includes paying attention to the dignity of people in the process of death. The dignity in the care of a dying person in the emergency department is defined by acknowledging the inherent value in each person, socio-environmental conditions and social and individual acceptance of death. Addressing these questions has significant repercussions for health professionals, especially nurses.

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Kimsma, Gerrit K., and Evert van Leeuwen. "From a Dutch Perspective: Response to “Rights of the Terminally Ill Act of the Australian Northern Territory” by Robert L. Schwartz (CQ Vol 5, No 1)." Cambridge Quarterly of Healthcare Ethics 5, no. 2 (1996): 278–80. http://dx.doi.org/10.1017/s0963180100007039.

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Bryon, E., B. D. de Casterle, and C. Gastmans. "Nurses' attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature." Journal of Medical Ethics 34, no. 6 (June 1, 2008): 431–36. http://dx.doi.org/10.1136/jme.2007.021493.

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Verulava, Tengiz, Mariam Mamulashvili, Iago Kachkachishvili, and Revaz Jorbenadze. "The Attitude of the Orthodox Parishioners Toward Euthanasia: Evidence From Georgia." International Quarterly of Community Health Education 39, no. 2 (December 27, 2018): 101–7. http://dx.doi.org/10.1177/0272684x18819963.

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Background The right of euthanasia is the subject of worldwide discussion today, as it is one of the most controversial medical, religious, political, or ethical issues. This study aims to survey the attitudes of Orthodox parishioners toward the euthanasia. Methods: Within the quantitative study, the survey was conducted through a semistructured questionnaire. Respondents were the parishioners of the Orthodox Church. Within the qualitative study, the survey of the experts of the Orthodox Church, in particular the clergy, was conducted. During the survey of the experts, we used the snowball method. Results The majority of respondents (81%) were aware of euthanasia. The dominant opinion is that euthanasia is “ the consent to life termination during the illness, when there is no way out and recovery is impossible” or “ a terminally ill person voluntarily decides to end life painlessly.” Those who disagree with euthanasia rely on the religious factors (why the church prohibits it). Those who agree with euthanasia action argue the legitimate human rights and free will of person. Most of the respondents (86%) have not heard about euthanasia practices in Georgia. Most of the respondents (71%) knew that the Orthodox Church prohibits euthanasia; 39% of the respondents believe that euthanasia is justified in medical terms. Conclusion It is advisable to raise public awareness on euthanasia in religious, medical, cultural, social, and legal aspects.

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