Current practices in managing end-of-life existential suffering.

PURPOSE OF REVIEW: Within the context of palliative care, existential suffering (ES) can be an exclusive source of suffering or intertwined with physical pain and/or psychological and spiritual suffering. With newly emerging modalities for addressing this phenomenon and its increasing salience given that many patients cite ES as a significant contributing factor to requests for hastened death, a review of recent interventions for addressing ES at the end of life is timely. RECENT FINDINGS: This review of newer approaches to dealing with ES in the palliative context suggests some promising new modalities and pharmacological interventions, such as brain stimulation and the use of psychedelics. The use of other pharmacological interventions, such as palliative sedation and lethal injections, solely for the alleviation of existential distress remains ethically controversial and difficult to disentangle from other forms of suffering, not least because a clear clinical definition of ES has yet to emerge in the literature. SUMMARY: The evaluation of end-of-life (EOL) ES mitigating tools should also consider how broader contexts, such as institutional arrangements and barriers, and cultural factors may influence the optimal management of dying persons' ES in the palliative care setting.

"HIV isn't me ": HIV+ adolescents' experiences in a positive context of support and treatment.

We describe the experiences of a sample of Canadian HIV+ youth whose intact adolescent identities contrast sharply with the expected identity challenges of persons living with a serious, chronic disease. We first showcase the positive HIV+ identities emerging from the successful management of HIV+ status through long-term HIV-related medical care and established pharmaceutical regimes. Second, we describe the medical, familial, and broader social context of support in which these adolescents' are negotiating HIV. Finally, we highlight the youth's expectations of future, specific identity and role challenges regarding intimacy and sexuality-related to disclosure of their private HIV+ identities and their embodied HIV+ status. Continued social and medical supports will be key to their emergence into adulthood as healthy HIV+ persons; with such supports, these youths' experiences highlight the capacity for living optimally with HIV.