An overview of the adverse effects of cannabis use for Canadian physicians.

PURPOSE: Cannabis is the most widely used illicit substance and one of the most commonly used psychoactive substances in the world, preceded only by alcohol, tobacco and caffeine. Recent changes in legislation regarding cannabis use in Canada and potential upcoming changes worldwide may have a further impact on the prevalence of cannabis use. Thus, it is critical to understand the risks and potential adverse health effects of acute and long-term cannabis use. Current literature is lacking in many areas surrounding cannabis use, and for the most part is unable to provide clear associations once confounding variables are considered. Here we provide a general overview of the history of cannabis, the physical and mental health consequences, and the risks to specific groups. SOURCE: A scoping search of published articles in PubMed from the start date (1946) until 2018. PRINCIPAL FINDING: Current evidence supports an association between cannabis use and mild respiratory and cardiac effects, but no clear increased risk of cancer. Psychiatric disorders, including schizophrenia and anxiety, show associations with cannabis use; however, a causal effect of cannabis use is unclear. While no evidence for increased risk in pregnancy has been found, risk is still undetermined. Youth may be at a greater risk as earlier initiation of use increases the risk of adverse health effects. CONCLUSION: Overall, evidence for direct and long-term adverse effects of cannabis use is minimal and additional longitudinal studies will be required to better delineate unidentified effects.

Withdrawal of life support and chaplaincy in Australia.

OBJECTIVE: To explore the role of health care chaplains in providing pastoral care to patients, their families and clinical staff considering decisions to withdraw life support. METHODS: Quantitative data were obtained retrospectively from a survey of 327 Australian health care chaplains (both staff and volunteer chaplains) to initially identify chaplaincy participation in withdrawal-of-life-support issues. Qualitative data were subsequently obtained by in-depth interview of 100 of the surveyed chaplains and thematically coded using the World Health Organization Pastoral Intervention (WHO-PI) codings to explore chaplains' roles. RESULTS: Over half the staff chaplains surveyed (57%) and over a quarter of the volunteer chaplains (28%) indicated that they had been involved with patients or their families in withdrawal-of-life-support decisions. Over a third of staff chaplains (37%) and 16% of volunteer chaplains had assisted clinical staff concerning withdrawal-of-life-support issues. The qualitative data revealed that chaplains were involved with patients, their families and clinical staff at all levels of pastoral intervention, including "pastoral assessment", "pastoral ministry", "pastoral counselling and education" and "pastoral ritual and worship". The specific nature of chaplaincy involvement varied considerably depending on the idiosyncratic issues faced by patients, families and clinical staff. These activities indicated that pastoral care could be provided for the support and benefit of patients, their families and clinical staff facing a complex bioethical issue. CONCLUSIONS: Through a variety of pastoral interventions, some chaplains (mostly staff chaplains) were involved in assisting patients, their families and clinical staff concerning withdrawal-of-life-support issues and thus helped ensure an holistic approach within the health care context. Given this involvement and the future potential benefit for patients, families and clinical staff, there is a need to develop continuing education and research on pastoral care and chaplaincy services.

Home parenteral nutrition: an ethical decision making dilemma.

Ethics is a hot topic these days. Home health care providers need not be ethicists, however they do need to be able to identify problems quickly, and know how to address them. This paper explores the ethical issues arising from a narrative analysis involving an advanced cancer patient receiving Total Parenteral Nutrition (TPN) at home. It shows how complicated it is today to make nutrition support decisions that would have been customary less than 30 years ago. For and against arguments of TPN for advanced cancer patients are reviewed. Ethical positions adopted by the medical and nursing professions are explored and contrasted. The importance of patient autonomy, within a holistic notion of care, including decisions incorporating quality of life, are affirmed, providing a challenge to monitoring the status quo in approaches to decision making.