BMC CANCER | Online – 16 December 2014 – Of 2,037 identified patients from four countries [Belgium (BE), The Netherlands (NL), Italy (IT) and Spain (ES)], four out of five lived at home or with family in their last year of life. Over 50% of patients had at least one transition in care settings in the last three months of life; one third of patients in BE, IT and ES had a last week hospital admission and died there. In the last week of life, a treatment goal was adopted for 80-95% of those having palliation/comfort as their treatment goal. Cross-country differences in end-of-life care provision included GPs in NL being more involved in palliative care (67%) than in other countries (35-49%) ... and end-of-life topics less often discussed in IT or ES. Preference for place of death was less often expressed in IT and ES (32-34%) than in BE and NL (49-74%). Although palliative care was the main treatment goal for most cancer patients at the end of life in all four countries, frequent late hospital admissions and the symptom burden experienced in the last week of life indicates that further integration of palliative care into oncology care is required in many countries.
CLINICAL RESEARCH & BIOETHICS | Online – 31 October 2014 – Medical futility generally refers to the inappropriate application of medical intervention that is unlikely to produce any significant benefit for the patient. Medical futility, once called "a problem without a name," remains a controversial issue in its definition as well as in its applications. The controversy exists, partly, in disagreements between families and physicians about the patient's best interests, the goals of treatment and the ends of medicine. In everyday clinical practice, physicians are under pressure to make decisions whether or not to offer futile treatment and how to communicate their decisions with the family. However, in some cases there are disagreements between healthcare providers and patients' family about the course of action. The inevitability of human death, limitations of medical science, the scarcity of health resources, and various socio-cultural issues shape decisions regarding end-of-life care in general and medical futility in particular. In an era with an aging population and escalating healthcare costs, the futility debate has become the object of extended critical attention. Currently, except in some hospitals in the U.S., there is a lack of policy or regulation in dealing with medical futility. It is crucial to develop futility policies which guide healthcare professionals on the process for decision making on the treatment options, and when it is morally permissible to withhold or withdraw life-sustaining treatment. Such policies would be very instrumental in decreasing disagreement.
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA, 2014; 22(2): 77-111. Both Islamic and Western bioethics perceive autonomy as an integral element that must be respected in developing and preserving a positive and ethical doctor patient relationship. The eclipse of paternalism and deference towards greater patient autonomy, which currently form the trend in modern medical practice however, have raised a lot of concern among ethicists and doctors alike. There is general agreement that the fundamental liberty of the individual to self-determination cannot and should not be undermined. Allowing unrestricted exercise of this right however would place untenable responsibility on the patient in making complex medical decisions and relegate the doctor's duty to no more than a passive informer, rather than one whose duty is to care for the patient, prevent harm and act in the latter's best interests. In this respect, both Islamic and Western bioethics recognize that patient autonomy is not an absolute or predominant concept and is subject to limitations. There are accordingly both similar and different limitations between the Islamic and Western models with regard to the concept of autonomy, but they attend to the same purpose. Such limitations, instead of infringing the right of autonomy, serve to enhance the content and respect for patient autonomy by ensuring that it is guided and applied appropriately in consonance with other bioethical principles (in the case of Islamic bioethics, the governing principles of the Sharī'ah), leading to effective and sound decision-making, and an overall improved healthcare environment. Medical decision-making should not be a purely medical judgment but a combined opinion between the doctor and the patient. Autonomous medical choices are usually enhanced rather than undermined by a process of shared decision-making that is intrinsically valuable in modern medical practice.
JOURNAL OF PALLIATIVE CARE & MEDICINE | Online – 8 November 2014 – This review testifies the lack of publications regarding programs designed and developed to support family caregivers in palliative care. It is shown that caregivers benefit from support groups and educational programs to promote information and caregiver training, but perhaps the lack of funding for this kind of intervention can affect the caregiver's treatment.
MAI JOURNAL, 2014; 3(2):140-152. This article focuses on the cultural resources that made Māori carers resilient when providing care to an ill family member at the end of life. Caring often took place against a backdrop of poverty, personal factors, racism and a lack of health literacy affecting access to resources. The action values of aroha (love, care, concern, compassion) and manaakitanga (hospitality, kindness, generosity), compassionate giving, caring, receiving and sharing established a resilient foundation upon which whānau (family, including extended family) engaged in the illness-to-death trajectory. It served to fortify the dying and their whānau and provided a sense of belonging and a meaningful way of engaging with illness, dying, death and bereavement. More information.
Media Watch is intended as an advocacy and research tool. The weekly report, published by Barry R. Ashpole, a Canadian communications consultant and educator, monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. Each month, this section of the IAHPC will publish an abstract or summary of an article or report of special interest noted in a recent issue of Media Watch (see below).