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Physician assisted death

John W Wax, Amy W An, Nicole Kosier, Timothy E Quill
Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support...
March 2018: Journal of the American Geriatrics Society
Alana M Vivolo-Kantor, Puja Seth, R Matthew Gladden, Christine L Mattson, Grant T Baldwin, Aaron Kite-Powell, Michael A Coletta
INTRODUCTION: From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination. METHODS: Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016-September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics...
March 9, 2018: MMWR. Morbidity and Mortality Weekly Report
Franklin G Miller, Paul S Appelbaum
No abstract text is available yet for this article.
March 8, 2018: New England Journal of Medicine
M A Almeida, E Araujo Júnior, L Camano, A B Peixoto, W P Martins, R Mattar
OBJECTIVE: To evaluate the incidence of, indications of, and maternal and neonatal morbidity and mortality rates in cesarean sections in a private health service in Brazil. DESIGN: Retrospective and observational study. SETTING: Private health service in Vitória, Espírito Santo, Brazil. METHODS: The patients were interviewed using a structured questionnaire to determine maternal age, gestational age at the time of delivery, number of previous deliveries, type of delivery performed, duration of labor, indications for cesarean delivery, point at which cesarean section was performed, physician responsible for delivery, and maternal morbidity, fetal morbidity, and fetal mortality rates...
2018: Ceská Gynekologie
JaBaris D Swain, Colleen Sinnott, Suellen Breakey, Rian Hasson Charles, Gita Mody, Napthal Nyirimanzi, Ceeya Patton-Bolman, Patricia Come, Gapira Ganza, Emmanuel Rusingiza, Nathan Ruhamya, Joseph Mucumbitsi, Jorge Borges, Martin Zammert, Jochen D Muehlschlegel, Robert Oakes, Bruce Leavitt, R Morton Bolman
OBJECTIVE: Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease...
February 27, 2018: Journal of Thoracic and Cardiovascular Surgery
Jonathan K Ehrman, Clinton A Brawner, Ali Shafiq, David E Lanfear, Matthew Saval, Steven J Keteyian
BACKGROUND: This study evaluated if different prognostic characteristics exist for peak VO2 , percent predicted peak VO2 (ppVO2 ), and the VE -VCO2 slope between men and women with heart failure and reduced ejection fraction (HFrEF). METHODS: Analysis of the FIT-CPX database (n=1,085; 33% women, 55% black) of individuals with HFrEF who completed a physician-referred CPX between 1997 and 2010. Primary outcome was a composite of all-cause death, left ventricular assist device (LVAD) placement, and orthotopic heart transplant (OHT)...
February 26, 2018: Journal of Cardiac Failure
Erin L Thompson, P S S Rao, Christopher Hayes, Catherine Purtill
BACKGROUND: The Centers for Disease Control and Prevention (CDC) reports a 200% escalation in the rate of opioid overdose deaths in the United States. Unfortunately, Ohio has been deemed the epicenter of the nation's opioid epidemic. In 2015, Ohio passed a bill that permits a pharmacist to distribute naloxone without a prescription. OBJECTIVES: This survey was aimed to discover pharmacists' knowledge of naloxone and Ohio law, perceived barriers that may prohibit naloxone dispensing, and Ohio pharmacists' general confidence, comfort, perception, and experience dispensing naloxone per physician protocol...
January 1, 2018: Journal of Pharmacy Practice
Robert Preston
Background: Physician-administered euthanasia (PAE) was legalized, along with physician-assisted suicide (PAS), in The Netherlands in 2001. Sources of data: Annual reports of the Dutch Regional Euthanasia Review Committees, the committees' 2015 published Code of Practice and research studies. Areas of agreement: There is a general openness about the practice of PAE/PAS in The Netherlands and an avoidance of misleading euphemisms. The 2001 law also includes arrangements for post-event review of PAE/PAS decisions...
February 12, 2018: British Medical Bulletin
Priya N Bhat, John M Costello, Ranjit Aiyagari, Paul J Sharek, Claudia A Algaze, Mjaye L Mazwi, Stephen J Roth, Andrew Y Shin
Introduction Diagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU. METHODS: Paediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015...
February 7, 2018: Cardiology in the Young
Meng-Ping Wu, Chao-Ming Huang, Wen-Jung Sun, Chih-Yuan Shih, Su-Hsuan Hsu, Sheng-Jean Huang
The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital...
February 2018: Hu Li za Zhi the Journal of Nursing
Nicolas Terzi, Frédéric Lofaso, Romain Masson, Pascal Beuret, Hervé Normand, Edith Dumanowski, Line Falaize, Bertrand Sauneuf, Cédric Daubin, Jennifer Brunet, Djillali Annane, Jean-Jacques Parienti, David Orlikowski
BACKGROUND: Identifying patients at high risk of post-extubation acute respiratory failure requiring respiratory or mechanical cough assistance remains challenging. Here, our primary aim was to evaluate the accuracy of easily collected parameters obtained before or just after extubation in predicting the risk of post-extubation acute respiratory failure requiring, at best, noninvasive mechanical ventilation (NIV) and/or mechanical cough assistance and, at worst, reintubation after extubation...
February 5, 2018: Annals of Intensive Care
N M Panhuyzen-Goedkoop, H T Jørstad, J L R M Smeets
Sudden cardiac arrest or death (SCA/SCD) in athletes has a low event rate. Pre-participation or eligibility screening is a widely accepted method of primary prevention of SCA/SCD in athletes. Most European countries and international sports governing bodies perform ECG-inclusive screening. However, implementation of a resting 12-lead ECG in pre-participation or eligibility cardiac screening is still a topic of debate. Recently, the 'International recommendations for electrocardiographic interpretation in athletes' was published in three leading international medical journals...
February 1, 2018: Netherlands Heart Journal
Ilana F Gareen, Bruce E Hillner, Lucy Hanna, Rajesh Makineni, Fenghai Duan, Anthony F Shields, Rathan M Subramaniam, Barry Siegel
We have previously reported that positron emission tomography using 18F-fluoride (NaF-PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF-PET results and hospice claims within 180 days and 1-year survival. Methods: We classified NOPR NaF-PET results linked to Medicare claims by imaging indication [initial staging (IS); detection of suspected first osseous metastasis (FOM); suspected progression of osseous metastasis (POM); or treatment monitoring (TM)] and type of cancer (prostate, lung, breast or other)...
December 28, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Courtney S Pilkerton, Sarah S Singh, Thomas K Bias, Stephanie J Frisbee
OBJECTIVES: Cardiovascular disease (CVD) remains the leading cause of death in the USA. Reducing the population-level burden of CVD disease will require a better understanding and support of cardiovascular health (CVH) in individuals and entire communities. The objectives for this study were to examine associations between community-level healthcare resources (HCrRes) and CVH in individuals and entire communities. SETTING: This study consisted of a retrospective, cross-sectional study design, using multivariable epidemiological analyses...
December 14, 2017: BMJ Open
Michele Augusto Riva, Michela Caramella, Massimo Turato, Giancarlo Cesana
BACKGROUND: The year 2017 marks the centenary of the death of the Italian scientist Pier Diego Siccardi (1880-1917), one of Luigi Devoto's assistants at the "Clinica del Lavoro" in Milan. OBJECTIVES: To commemorate Siccardi and to describe the activities of the physicians of the "Clinica del Lavoro" during World War I. METHODS: A comprehensive analysis was conducted on scientific papers written by Pier Diego Siccardi and by other physicians belonging to the Clinica del Lavoro, in the period 1915-1918...
December 14, 2017: La Medicina del Lavoro
Sandra Marquez Hall, Janet Lieto, Roy Martin
During a mandatory fourth-year core geriatric medicine rotation at our medical school, we discovered that our medical students were struggling with end-of-life (EOL) issues both personally and professionally. We implemented curriculum changes to assist them in developing emotional awareness about death and dying, and to help develop their ability to respond personally and professionally to patients and their families during EOL experiences.In our new curriculum, a seasoned ethicist at our university conducts 2 educational sessions addressing EOL issues...
2017: Permanente Journal
Aimee V Hamel, Joseph E Gaugler, Carolyn M Porta, Niloufar Niakosari Hadidi
BACKGROUND: Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making...
December 11, 2017: Journal of Cardiovascular Nursing
Matti Häyry
Fear of life, fear of death, and fear of causing death form a combination that prevents reasoned changes in laws concerning end-of-life situations. This is shown systematically in this article using the methods of conceptual analysis. Prevalent fears are explicated and interpreted to see how their meanings differ depending on the chosen normative stance. When the meanings have been clarified, the impact of the fears on the motivations and justifications of potential legislative reforms are assessed. Two main normative stances are evoked...
January 2018: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Amanda Landers, Rachel Wiseman, Suzanne Pitama, Lutz Beckert
Patients with severe chronic obstructive pulmonary disease (COPD) have a chaotic trajectory towards death. Research has focused on identifying a "transition point" that would allow identification of those patients who may benefit from a palliative approach to their care, or referral to a specialist palliative care service. This article aims to outline difficulties in identifying this transition point, summarise current literature on this topic and suggests a model based on clinical milestones. Educational aims: To outline the difficulties associated with identifying patients with severe COPD who are at risk of dying...
December 2017: Breathe
Daphne K Sharpe, Jasmine K Hall, Sochima Ochije, Rahn K Bailey
In 2000, the Institute of Medicine stunned many professionals with their published report that noted the vast number of deaths that occur each year in hospitals across the United States which reach as many as 98,000. Therefore, it comes as no surprise that the healthcare arena faces litigious issues regularly, with some specialties budgets being significantly impacted by the cost of maintaining liability insurance. Legal Nurse Consultants and forensic physicians working in tandem but who work independently from treating clinicians can carry out forensic independent medical examinations (IME)...
March 2018: Medico-legal Journal
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