Health benefits for the terminally ill: reality and perception

This paper examines the availability and scope of hospice benefits as well as employers' attitudes and knowledge about care for the terminally ill. Data are drawn from a national random sample of 1,502 employers with 200 or more workers and from focus groups with employee benefits managers and their insurance advisers, brokers, and consultants. Major findings are that 83 percent of employers offer explicit hospice benefits, with most other firms covering hospice through high-cost case management. Most employers support the concept of hospice care because they believe that it reduces medical expenses.     

Dehydration of the terminally ill

Prevision for the next future in a dramatic advances era we are living now has to be based upon fields consistently correlated to significative and immediately employable developments. Technical improvements in the next future, at the beginning of the third millennium, may schematically identified into two basic domains: the former, concerning surgical techniques; the latter, dealing with endovascular and neuroendoscopic techniques.     

The care of the terminally ill patient

Drs. Alejandro Goic (internist), Ramón Florenzano (psychiatrist), Bernardino Pi?era (physician and Catholic Bishop), Sergio Valdés (internist) and Rodolfo Armas (internist) participated in a round table about the care of the terminally ill, during a Postgraduate Course organized by the Chilean Society of Gastroenterology. After a general introduction, participants discussed the psychological aspects of terminally ill patients, about the sense of death from a Christian anthropological perspective, the terminally ill in intensive care units and finally about the education of medical students in this frequently neglected aspect of medical practice.     

The role of euthanasia in the terminally ill

Nurses involved in HIV/AIDS care must contend with many practical, professional and ideological issues. In doing so they must also be activists for social justice and human rights in health care, especially in countries where poverty and lack of knowledge are inextricably linked to the spread of HIV. Below, a report on where nurses are and should be going in Africa.     

The role of euthanasia in the terminally ill

Smoking, lipid disorders, hypertension and diabetes are well known risk factors for cardiovascular disease. Many individuals are characterised by a genetically determined predisposition and moreover, psychosocial factors and an inappropriate life style may exert adverse effects on biological variables. Evidence exists which suggests that in such cases various ageing processes may be accelerated. Studies of apoptosis regulation can yield improved understanding of such phenomena as atherosclerotic plaque rupture and such structural cardiovascular changes as left ventricular hypertrophy. A possible clinical result of such events may be manifest myocardial infarction, followed by heart failure and a predisposition to arrhythmia. The recent identification of apopain, a proteolytic enzyme associated with apoptosis, may eventually enable drugs to be developed for the regulation of apoptosis.     

Therapeutic intervention with terminally ill children: A review.

Reviews the literature of psychological treatment strategies used with terminally ill children to provide a framework for psychological intervention in a pediatric setting. Topics discussed include the responsibilities of the professional role, the emotional and developmental impacts of long-term hospitalization, and therapeutic goals—which involve normalization, developing mastery and self-esteem, enhancement of social support, and the provision of information about symptoms, complications, and treatments. Interventions include individual, group, and play therapies, and consulting with other hospital personnel. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope in the family caregiver of terminally ill people

This longitudinal study explored the meaning of hope, the influence of specific background characteristics on hope, and identified strategies that are used to foster hope in a convenience sample of 25 family caregivers of terminally ill family members from two hospice programmes using the technique of methodological triangulation (interview, Herth Hope Index and Background Data Form). Hope was defined as a dynamic inner power that enables transcendence of the present situation and fosters a positive new awareness of being. Six hope-fostering categories and three hope-hindering categories were identified based on the interview responses. With the exception of those providing care to a family member diagnosed with AIDS and those caregivers experiencing poor personal health, a high fatigue level, severe sleep deprivation and more than two concurrent losses, overall hope levels among participants were found to remain stable across the background variables. Across time, hope levels were found to be low at interview time one, rise significantly by time two and then level off for the remainder of the time. An understanding of hope from the perspective of the family caregiver could provide a basis upon which to develop interventions that foster hope.     

Subcutaneous morphine infusion by syringe driver for terminally ill patients

We describe a 16-year-old boy with reflex sympathetic dystrophy after a fracture of the right hand. He had inflammation of the proximal nail folds and arrested nail growth of digits 3, 4 and 5 on the right hand. After 2 months lymphatic drainage treatment, the changes of the nails had disappeared.     

From despair to integrity: An Eriksonian approach to psychotherapy for the terminally ill.

Psychotherapy with the terminally ill is based on the view that every life is worth living to the very end. Individual, group, family, and hypnotic psychotherapies with the terminally ill are discussed. The goals are to enrich the last days of life, deal with unfinished business, increase social and family cohesion, and serve as a preparation for a truly good death. The various procedures that have been utilized are reviewed, together with the qualities required of the psychotherapist. The reasons for the avoidance of working with the terminally ill are discussed. Such treatment is a rewarding, life-affirming, and growth experience for both the patient and the therapist. Brief cases are presented to illustrate the special nature of the doctor–patient relationship and the ways in which the doctors were able to establish contact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Euthanasia and the terminally ill: can the civil killing of others be eroded?

Hysterectomy is associated with severe constipation in a subgroup of patients, and an adverse effect on colonic motility has been described in the literature. The onset of irritable bowel syndrome and urinary bladder dysfunction has also been reported after hysterectomy. In this prospective study, we investigated the effect of simple hysterectomy on ano-rectal physiology and bowel function. Thirty consecutive patients were assessed before and 16 weeks after operation. An abdominal hysterectomy was performed in 16 patients, and a vaginal procedure was performed in 14. The parameters measured included the mean resting, and maximal forced voluntary contraction anal pressures, the recto-anal inhibitory reflex, and rectal sensation to distension. In 8 patients, the terminal motor latency of the pudendal nerve was assessed bilaterally. Pre-operatively, 8 patients were constipated. This improved following hysterectomy in 4, worsened in 2, and was unchanged in 2. Symptomatology did not correlate with changes in manometry. Although, the mean resting pressure was reduced after hysterectomy (57 mmHg-53 mmHg, P = 0.0541), the maximal forced voluntary contraction pressure was significantly decreased (115 mmHg-105 mmHg, P = 0.029). This effect was more pronounced in those with five or more previous vaginal deliveries (P = 0.0244, n = 9). There was no significant change in the number of patients with an intact ano-rectal inhibitory reflex after hysterectomy. There was no change in rectal sensation to distension, and the right and left pudendal nerve terminal motor latencies were unaltered at follow-up. Our results demonstrate that hysterectomy causes a decrease in the maximal forced voluntary contraction and pressure, and this appears to be due to a large decrease in a small group of patients with previous multiple vaginal deliveries.     

Beneficent voluntary active euthanasia: a challenge to professionals caring for terminally ill patients

Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his 'conscience is clear' and that the time has come to confront the issue of euthanasia. For the purposes of this article, the term 'beneficient voluntary active euthanasia' (BVAE) will be used: beneficient from the prima facie principle of beneficience, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means 'good death'. This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community. The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths.     

Accuracy of clinical prediction of survival for terminally ill cancer patients

Accurate estimation of survival is vital for effective palliative care. To verify the value of clinical prediction of survival (CPS), a prospective study was performed on 150 terminally ill cancer patients. The CPS was highly correlated with actual survival (AS), but the accuracy was not significantly superior to the prediction by performance status alone. Serious pessimistic error, defined as AS was at least 28 days and twice as long as CPS, was recognized in 13%, while serious optimistic error, defined as AS was less than 28 days and half as long as CPS, in 15%. The frequency of serious error was not significantly different by physicians' experiences, patients' age, sex, primary disease, and metastatic locations, but was significantly higher in cases with better performance status. Also, unexpected changes resulting in death were experienced in 42% of another 186 cases. The main underlying causes were pneumonia, bleeding, heart failure, intestinal perforation, cerebrovascular disease, hepatic/renal failure, hypoglycemia, sepsis and electrolyte imbalance. Clinical prediction was not sufficiently reliable and must be further improved.     

Building bridges: Psychologists and families of the mentally ill.

Describes problems faced by families of the mentally ill, particularly since the caregiving system in the US provides only incomplete solutions. Psychologists have provided important support to family members coping with seriously mentally ill relatives; however, psychology's response has been incomplete. Families have helped themselves in the initiation in 1979 of the National Alliance for the Mentally Ill (NAMI), an advocacy and education organization that originated as a network of mutual support groups. The history of communication between NAMI and the American Psychological Association (APA) is outlined. The need for "building bridges" between psychologists and families of the mentally ill resulted in 2 conferences between APA and NAMI. Other steps to enhance communication between psychologists and these families are listed, including communication with legislatures and the general public about public policy agendas on mental health services and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Principles for the discussion of life and death options with terminally ill clients with HIV.

Professional psychologists will increasingly have a role in discussing life-and-death options for terminally ill patients. Under certain circumstances, the desire to hasten one's death may be viewed as legitimate. The authors suggest principles for clinical discussion with terminally ill clients with HIV and outline a decision process to assist in determining whether a client's wish to die is well reasoned and that all alternatives have been considered. The authors describe a collaborative decision-making model for use in discussing life-and-death decisions and lay out a series of principles to guide therapist–client discussion of this very difficult decision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The feasibility and advisability of administering home blood transfusions to the terminally ill patient

21 patients with seasonal allergic rhinoconjunctivitis (SAC) entered the trial of a new topical antihistamine drug histimet (levocabastine). The drug is available as a nasal spray and eye drops. The relief of the main symptoms of SAC occurred 15-20 min after histimet introduction into the nose or eye. The effect of a single procedure lasted for 12 hours. Regression of SAC basic symptoms continued for 7 days after using histimet. A significant improvement of life quality was observed. Good effect achieved in 90% of the patients characterizes histimet as an effective new modality in SAC management.