ABSTRACT
A young, still multimorbid woman aquires infectious endocarditis. Anamnestically severe non-adherence concerning medical advice is reported. Complete cure may only be achieved by performing surgical heart valve replacement, which implies lifelong scrupulous oral anticoagulation postoperatively. Discussion evolves within medical staff, whether surgery should be indicated or not.
Subject(s)
Decision Making , Endocarditis/surgery , Heart Valve Prosthesis Implantation , Patient Compliance , Adult , Female , Humans , Mitral Valve/surgeryABSTRACT
Chronic and progressive disease represents a significant risk factor for suicidal behavior. Cancer patients have almost twice the rate of suicides compared to the general population. Based on a case report, the suicidal risk factors for cancer patients are presented. It is further investigated to what extent professional support by a mobile palliative care team can affect the wish for assisted suicide or the suicidal behavior generally among patients receiving palliative care. In addition, the mental impact on individuals, who were witnesses of assisted suicide of relatives or close friends are presented. The occurrence of posttraumatic stress disorder (PTSD), depressions, anxiety disorders and complicated grief (CG) in close family members is shown. However, further research will be necessary to develop adequate support for patients (and their relatives), who plan an assisted suicide.
Subject(s)
Bereavement , Caregivers/psychology , Cost of Illness , Neoplasms/psychology , Suicide, Assisted/psychology , Carcinoma, Small Cell/psychology , Character , Female , Humans , Lung Neoplasms/psychology , Middle Aged , Motivation , Personal Autonomy , Risk Factors , Spouses/psychology , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Suicidal thoughts are a common phenomenon in palliative care which can be seen in around 10% of the patients. There is very little knowledge about attempted and committed suicide. This article is a case report about a patient with lung cancer in a terminal state of illness who ingested drugs in a toxic dose while receiving palliative home care. This article deals with ethical issues in medical treatment and various ways of decision-making.
Subject(s)
Bromazepam/poisoning , Carcinoma, Bronchogenic/psychology , Diazepam/poisoning , Drug Overdose/psychology , Home Care Services , Lung Neoplasms/psychology , Palliative Care/psychology , Suicide/psychology , Tramadol/poisoning , Aged, 80 and over , Austria , Decision Making/ethics , Dyspnea/psychology , Dyspnea/therapy , Ethics, Medical , Home Care Services/ethics , Humans , Male , Pain Management/ethics , Pain Management/psychology , Palliative Care/ethics , Suicidal Ideation , Terminal Care/ethics , Terminal Care/psychologyABSTRACT
The debate on euthanasia that has been started all over Europe, but especially in Germany has been particularly complicated by unclear and inconsistent definitions. Medical decisions in end-of-life care gain increasing importance not only for the time of death but also for the kind and quality of the dying process. Though legal regulations can help to diminish doubts about the permissibility of various measures in end-of-life care, teaching and knowledge of ethical principles, communication skills, respect, transparency and knowledge of palliative care options seem to be the most important factors in accompanying the dying professionally and with dignity and even in achieving a consented compromise when aid in hastening death is asked for.
Subject(s)
Euthanasia/legislation & jurisprudence , Terminal Care/legislation & jurisprudence , Terminal Care/standards , Communication , Ethics, Medical , Germany , Health Knowledge, Attitudes, Practice , HumansABSTRACT
In this paper ethical questions concerning the limitation and termination of medical treatment of comatose patients will be discussed on the basis of a case study. The team is confronted with extremely high communicative and ethical demands, since every person engaged in the treatment and care of the patient should take part in this decision making process. The final responsibility regarding the medical decisions, however, lies with the doctor in charge. In such cases advance directives or living wills are important and should be taken into consideration.
Subject(s)
Chordoma/therapy , Cranial Fossa, Posterior , Ethics, Medical , Neoplasm Recurrence, Local/therapy , Palliative Care/ethics , Skull Base Neoplasms/therapy , Advance Directives/ethics , Advance Directives/legislation & jurisprudence , Aged , Austria , Chordoma/diagnosis , Disease Progression , Humans , Informed Consent/ethics , Informed Consent/legislation & jurisprudence , Life Support Care/ethics , Male , Medical Futility/ethics , Medical Futility/legislation & jurisprudence , Mental Competency/legislation & jurisprudence , Neoplasm Recurrence, Local/diagnosis , Personal Autonomy , Quality of Life/legislation & jurisprudence , Skull Base Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. METHODS: Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995-2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995-1999 and 2000-2002. RESULTS: 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000-2002. CONCLUSION: Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory and intolerable symptoms, patients' informed consent and personal needs, the goals and aims of medical sedation in end-of-life care.
