ACTA BIOETHICA, 2015;21(2):173-182. Three East Asian countries, Korea, China, and Japan, have shared a similar cultural background throughout history. This is the basis of the assumption of Asian values in the field of bioethics. However, different processes of modernization and healthcare systems have resulted in considerable differences. Along with the aging process, end-of-life care issues have been increasing in importance in these three countries. The authors conducted a study of 899 lay persons in three countries regarding their perspectives about end-of-life decisions: 1) Favorable ways of decision-making in end-of-life care; 2) Institutional and legal devices; 3) Withdrawal of life-sustaining treatment; and, 4) Euthanasia. They confirmed several similarities and noted some differences among the three countries.
AUSTRALASIAN JOURNAL OF PARAMEDICINE, 2015;12(5):Article 3. Paramedics [i.e., survey respondents] have a sound grasp of some important aspects of palliative care (PC) including symptom control and the holistic nature of the palliative approach. They did, however, tend to equate PC with care occurring in the terminal phase and saw it as being particularly applied to cancer diagnoses. Paramedic PC educational efforts should be focused on: 1) Ethical issues; 2) End-of-life communication; 3) Increasing understanding of the common causes of death; and, 4) Education regarding those illnesses where a palliative approach might be beneficial.
CURRENT OPINION IN SUPPORTIVE & PALLIATIVE CARE, 2015;9(4):357-360. This systematic review resulted in 45 identified studies, 14 of which were considered: five works addressed the need for development and validation of spiritual tools; three reviewed tools for spirituality assessment, interventions, or related concepts; three more covered the efforts to define guidelines and priorities for spiritual care and its measurement. Other topics, such as pediatric spiritual care, the use of new technologies, or nationwide surveys, also arose. Recent contributions outline usability traits such as to shorten scales and measurement protocols for maximum respect of patients’ quality of life. Other works addressed complicated grief or satisfaction with attention to spiritual care, transcending the patients, family and professionals’ focus in a sort of combined perspective. Further attention to culturally based specific models, supporting questionnaires, a deeper understanding of quality of the spiritual care, both for patients and families, or further research on the relation between spiritual care and life span should be welcomed.
INDIAN JOURNAL OF CRITICAL CARE MEDICINE, 2015;19(11):655-660. End-of-life decisions are being made daily in Intensive Care Units worldwide. The spectrum of options varies from full-continued care, withholding treatment, withdrawing treatment, and active life-ending procedures depending on the institutional practices and legal framework. Considering the complexity of the situation and the legalities involved, it is important to have a structured approach toward these sensitive decisions. It does make sense to have a protocol that ensures proper documentation and helps ease the physicians involved in such decisions. Clear documentation in the format of a checklist would ensure consistency and help the entire medical team to be uniformly informed about the end-of-life plan.
MEDICAL JOURNAL OF MALAYSIA, 2015;70(5):295-299. Generally children with malignant disease appear to have a precocious understanding of the concepts of death. Their experiences during treatment might include the deaths of other patients, and they can sense the extraordinary stress of their parents and doctors when death is imminent, as well as feel tremendous isolation if they are not given permission to talk openly about their illness and impending death. Whilst knowledge of the developmental understanding of death and timing is critical when it comes to communicating with children, it is also important to be receptive to when the child is initiating a conversation. “Teachable moments” may be fleeting, and healthcare workers need to be trained and tuned to these moments, so that it can be capitalized with an immediate response. Parents who wish but do not know how to break the news to their child are offered assistance by trained staff. The practice of collusion and mutual pretence seems to be commonly adopted by Malaysian families. Asian cultural practices and beliefs may influence the degree of open communication that takes place. An individual is not autonomous but lives in the context of a family and community. In the case of minors and elders, healthcare decisions are often made by the family. As parents are the final arbiters on decisions and assent a collaborative disclosure process taking into account the family’s wishes within the context of its culture will likely offer greater benefit overall, than would overriding and undermining the parents’ role in promoting the long term autonomy and well being of their children.
PALLIATIVE MEDICINE | Online – 22 October 2015 – Do specialized palliative care services improve outcomes for patients with advanced progressive illness at the end of life and their families at lower or acceptable cost compared with traditional health and social care services? Health economics research can help answer this question. Economic evaluations systematically compare the relative costs and benefits of competing options and thus provide information about how best to improve patient and family outcomes within funding constraints. Costs and outcomes are jointly considered to evaluate how best to achieve value for money from scarce resources. However, there is sparse evidence on the efficiency and equity of palliative and end-of-life care, in part due to the difficulties associated with conducting research in this context, particularly measuring costs and outcomes. Informal caregivers, not healthcare systems, provide the majority of care for people at the end of life, yet health service evaluations often ignore both the outcomes and costs borne by this group.
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 Newsletter will publish an abstract or summary of an article or report of special interest noted in a recent issue of Media Watch (see below).