Let the Hospital's Conscience Be Your Guide: How Institutional Policies are Eroding 'Death with Dignity'

2014 ◽  
Author(s):  
Larissa Lee
Keyword(s):  
Institutional Policies ◽  
Death With Dignity

scholarly journals QOLP-26. USE OF MEDICAL ASSISTANCE IN DYING (“DEATH WITH DIGNITY”) IN WASHINGTON STATE PATIENTS WITH BRAIN TUMORS.

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii180-ii180
Author(s):  
Jerome Graber ◽  
Kaite Sofie ◽  
Lynne Taylor
Keyword(s):  
Brain Tumors ◽  
Terminal Illness ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
High Grade Glioma ◽  
Washington State ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Medical Assistance In Dying ◽  
Diagnosis Of Cancer

Abstract Since 2009, Washington State has had a “Death with Dignity” (DWD) process whereby people with a terminal illness may legally obtain a prescription for medications that will end their life. Patients initiate a voluntary request from two physicians certifying they have a prognosis < 6 months, are aware of other palliative care options, and have capacity without the comorbidity of a psychiatric diagnosis. Since 2015, over 200 people annually have used the DWD process in Washington. Other papers have described the characteristics of people using DWD with a diagnosis of cancer or amyotrophic lateral sclerosis (ALS) but none have specifically looked at patients with brain tumors (BT) who used DWD. We describe 20 people with BT who accessed DWD since 2015 at our center. Median age at the time of death was 51 (range 38-79) and 75% were men. Glioblastoma was the diagnosis in 10 (50%), anaplastic glioma in 8 (40%), grade II astrocytoma in 1, and a presumed high-grade glioma by imaging in 1. Median Karnofsky Performance Status (KPS) was 90 at diagnosis (range 50-100) and 70 at DWD request (range 40-90). Standard radiation (RT) and chemotherapy was used by 17 (85%) prior to DWD request, while 3 patients (15%, ages 70-79, KPS 50-90) requested DWD immediately after diagnosis and did not undergo further treatment. Pain was present in 4 patients (20%), 2 using opioids (10%). Six patients (30%) continued tumor treatments after approval for DWD. Median OS was 22 months (range 2-285) and 24 months excluding patients who declined treatment (range 8-285). Most glioma patients in our cohort requested DWD after undergoing chemoradiation, pain was uncommon and rarely severe, and survival from diagnosis was comparable to standard therapy. As access to medical assistance in dying continues, further research is needed on its utilization for people with brain tumors.

scholarly journals Considerations for Pediatric Retirement from Athletics Following Repetitive Concussive Traumatic Brain Injury: Incorporating the Right to an Open Future

2021 ◽  
Vol 18 (5) ◽  
pp. 2266
Author(s):  
Tyler S. Gibb ◽  
Kathryn Redinger ◽  
Casey Fealko ◽  
Sonia Parikh
Keyword(s):  
Clinical Evidence ◽  
Open Future ◽  
Short Term ◽  
Institutional Policies ◽  
Athletic Competition ◽  
Adolescent Athlete ◽  
Clinical Considerations ◽  
Federal Laws ◽  
The Right ◽  
Concussive Injury

Guidance regarding the decision to remove an adolescent from athletic competition immediately following an acute concussive injury and the safe return of play in the short term is widely accepted and supported by clinical evidence, local institutional policies, and state and federal laws. There is considerably less guidance regarding the decision to permanently retire an adolescent athlete for medical reasons due to concussive injuries. In this article, we discuss the clinical and non-clinical considerations that should guide clinicians in discussions regarding the adolescent athlete’s permanent retirement by emphasizing the ethical obligation to protect the child’s right to an open future as possibly determinative in otherwise ambiguous cases.

scholarly journals STEM Faculty Instructional Data-Use Practices: Informing Teaching Practice and Students’ Reflection on Students’ Learning

2021 ◽  
Vol 11 (6) ◽  
pp. 291
Author(s):  
Cindy Lenhart ◽  
Jana Bouwma-Gearhart
Keyword(s):  
Professional Development ◽  
Instructional Technology ◽  
Teaching Practice ◽  
Data Use ◽  
Faculty Members ◽  
Institutional Policies ◽  
Policies And Procedures ◽  
Stem Faculty ◽  
Standardized Curriculum ◽  
Learning Data

This paper explores the affordances and constraints of STEM faculty members’ instructional data-use practices and how they engage students (or not) in reflection around their own learning data. We found faculty used a wide variety of instructional data-use practices. We also found several constraints that influenced their instructional data-use practices, including perceived lack of time, standardized curriculum and assessments predetermined in scope and sequence, and a perceived lack of confidence and competence in their instructional data-use practices. Novel findings include faculty descriptions of instructional technology that afforded them access to immediate and nuanced instructional data. However, faculty described limited use of instructional data that engaged students in reflecting on their own learning data. We consider implications for faculty’s instructional data-use practices on departmental and institutional policies and procedures, professional development experts, and for faculty themselves.

Physicians' Experiences with the Oregon Death with Dignity Act

2000 ◽  
Vol 342 (8) ◽  
pp. 557-563 ◽  
Author(s):  
Linda Ganzini ◽  
Heidi D. Nelson ◽  
Terri A. Schmidt ◽  
Dale F. Kraemer ◽  
Molly A. Delorit ◽  
...  
Keyword(s):  
Death With Dignity ◽  
Death With Dignity Act ◽  
Dignity Act

Life after Death with Dignity: The Oregon Experience

Social Work ◽  
2000 ◽  
Vol 45 (3) ◽  
pp. 263-271 ◽  
Author(s):  
P. J. Miller
Keyword(s):  
Death With Dignity ◽  
Life After Death

Euthanasia Legislation: A Survey and A Model Act

1976 ◽  
Vol 2 (1) ◽  
pp. 41-99
Author(s):  
Ronald P. Kaplan
Keyword(s):  
Optimal Solution ◽  
State Legislators ◽  
Death With Dignity ◽  
Frequency State

With increasing frequency, state legislators have been proposing legislation which would permit euthanasia—the allowance of “death with dignity”—under certain circumstances. These proposals indicate varying degrees of awareness of the issues and problems involved in drafting euthanasia legislation. This Article focuses on such issues and problems, studies the methods proposed by legislators to deal with them, and offers a Model Euthanasia Act designed to achieve their optimal solution.

scholarly journals Structural stigma and its impact on healthcare for consumers with borderline personality disorder: protocol for a scoping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Pauline Klein ◽  
Alicia Kate Fairweather ◽  
Sharon Lawn ◽  
Helen Margaret Stallman ◽  
Paul Cammell
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Health Services ◽  
Health Systems ◽  
Scoping Review ◽  
Borderline Personality ◽  
Cochrane Library ◽  
Cultural Norms ◽  
International Literature ◽  
Institutional Policies

Abstract Background Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers’ access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families. Methods This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods. Discussion This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population. Systematic review registration Open Science Framework (https://osf.io/bhpg4).

Sign in / Sign up

Export Citation Format

Share Document