Abstract
Sulmasy DP, Finlay I, Fitzgerald F, et al.: Physician-assisted suicide: Why neutrality by organized medicine is neither neutral nor appropriate. J Gen Intern Med 2018;33:1394–1399.
It has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. In this perspective, the authors review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. They argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. They also argue that medical organizations already oppose many practices that are legal in many jurisdictions, and that unanimity among memberships has not been required for any other clinical or ethical policy positions. Moreover, on an issue so central to the meaning of medical professionalism, it seems important for organized medicine to take a stand. The authors subsequently review the arguments in favor of PAS [arguments from autonomy and mercy, and against the distinction between killing and allowing to die (K/ATD)] and the arguments against legalization (the limits of autonomy, effects on the patient–physician relationship, the meaning of healing, the validity of the K/ATD distinction, the social nature of suicide, the availability of alternatives, the propensity for incremental extension, and the meaning of control). They conclude that organized medicine should continue its opposition to PAS.
Meilaender G: Comforting when we cannot heal: The ethics of palliative sedation. Theor Med Bioeth 2018 [Epub ahead of print]; DOI:10.1007/s11017-018-9445-0.
This essay considers whether palliative sedation is or is not appropriate medical care. This requires one to consider (1) whether, in addition to the good of health, relief of suffering is also a proper end of medicine; (2) whether unconsciousness can ever be a good for a human being; and (3) how double-effect reasoning can help us think about difficult cases. The author concludes that palliative sedation may be proper medical care, but only in a limited range of cases.
Wagner AJM: Do not click “Like” when somebody has died: The role of norms for mourning practices in social media. Soc Med Soc 2018 [Epub ahead of print]; DOI:10.1177/2056305117744392.
Social media constitute new social spaces where the topics of death, loss, and mourning are increasingly encountered and negotiated. Users might either engage in mourning practices themselves or be confronted with other users' mourning during their everyday social media use. The omnipresence of mourning in social media poses challenges to users and increases the need for norms on how to engage in online mourning practices and how to react toward expressions of grief and mourning. This article systematically reviews 25 internationally published journal articles on norms guiding mourning practices and (non)reactions toward these practices in social media. Three different types of norms related to different forms of practices are identified in the review. Results show that norms for mourning in social media are in flux and consistently negotiated between users. However, norms for mourning in social media often adhere to traditional norms that are adapted and reconfigured.
Hinrichs KLM, Christie KM: Focus on the family: A case example of end-of-life care for an older LGBT veteran. Clin Gerontol 2018 [Epub ahead of print]; DOI:10.1080/07317115.2018.1504848.
The Department of Veterans Affairs (VA) is likely the largest provider of healthcare for lesbian, gay, bisexual, and transgender (LGBT) persons in the United States. However, histories of homophobia, stigma, discrimination, and past military policies have all had a lasting impact on the health of LGBT veterans. Effects can be seen across healthcare needs, disparities, access, and utilization for or by LGBT veterans. A case from a VA hospice unit is used to illustrate some challenges and opportunities when providing end-of-life care for an older lesbian veteran. This veteran had been cared for by her wife who was struggling to meet care needs at home. Over time, it became clear that the wife was emotionally and financially dependent on the veteran, and would be facing many psychosocial and financial challenges when the veteran died. However, the wife was reticent to accept referrals for help or services due to past negative experiences with social service agencies related to her sexual orientation. The interdisciplinary team collaborated to care for the veteran's medical needs, and the wife's emotional and psychosocial needs, until after the veteran's death. This case highlights many of the unique needs and challenges that may arise in caring for LGBT veterans and their families at end of life.
Sessions WS, Kow SY, Waldrop E, et al.: Breaking bad news and the importance of compassionate palliative care of the infant. Patient Experience J 2018;5:14–18.
Bad news to parents regarding their infant is information that negatively impacts the parent's feelings and view of the present and/or future. It is implemented in situations with feelings of no hope or those that induce a threat to a parent's mental and physical well-being. The term is difficult to define as it is based on parent's subjective feelings. However, it is important to be aware of the impact of bad news as it can cause severe anguish and stress on the parent's emotional stability. The style of delivering bad news has a significant impact on the physician–parent relationship and the satisfaction of the family upon the healthcare team and palliative care system. In the case of an inevitable death of an infant, the implementation of palliative care follows the delivery of bad news. The strategy of palliative care and the philosophy of communication between the healthcare provider and family unit leave a lasting impression on the parents regarding the care of their infant. Clinicians should strive to educate themselves regarding the art of breaking bad news as well as the approach to palliative care to minimize the suffering and grief of the family in their time of sorrow.
Pooler C, Richman-Eisenstat J, Kalluri M: Early integrated palliative approach for idiopathic pulmonary fibrosis: A narrative study of bereaved caregivers' experiences. Palliat Med 2018 [Epub ahead of print]; DOI:10.1177/0269216318789025.
Idiopathic pulmonary fibrosis has an uncertain and rapid trajectory after diagnosis. Palliative care is rarely utilized, although both patients and caregivers experience a distressingly high symptom burden. Most patients die in hospital. The purpose of this study was to explore bereaved caregivers' experiences and perceptions of an early integrated palliative approach implemented at a Multidisciplinary Interstitial Lung Disease Clinic. The design of the study was a narrative approach, with thematic and content analysis of open-ended interviews. The clinic is located in a large western Canadian city. Caregivers of deceased patients were recruited through purposive sampling. The eight participants were either spouses or adult children. Results demonstrated that five major themes were identified: having a terminal disease, planning goals and wishes for care, living life and creating memories, feeling strain and responsibility, and nearing the end. Caregivers had little understanding of prognosis before advance care planning conversations at the clinic. Advance care planning conversations enabled caregivers to know and support patients' goals and wishes. Caregivers described feeling informed, prepared, and supported when death was near. They expressed neither distress nor anxiety related to patients' symptoms or strain of relationships. The authors conclude that collaboration and close communication among caregivers, pulmonary physicians, and home care staff enabled effective symptom management and out-of-hospital deaths. Patients and caregivers had opportunities to enjoy events, create memories, determine preferences, and make plans. The authors suggest that further research on an early integrated palliative approach in idiopathic pulmonary fibrosis is warranted related to quality of life, experience with death and dying, and caregiver bereavement.