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N Engl J Med ; Sykes N, Thorns A.

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Users Online: Palliative sedation and ethical dilemma. Related articles Ethical palliative sedation unnecessary suffering. Access Statistics. Sitemap What's New Feedback Disclaimer. A clearer usage is palliative, noncurative therapy when that is what is meant, because palliative care can be used along with curative or aggressive therapies. Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat pain related to an influenza infection.

Palliative care is given to people who have any serious illness and who have physical, psychological, social, or spiritual distress as a result of the treatment they are seeking or receiving. Palliative care is not reserved for people in end-of-life care and can improve quality of life , decrease depressive symptoms, and increase survival time. In some cases, medical specialty professional organizations recommend that sick people and physicians respond to an illness only with palliative care and not with a therapy directed at the disease.

The following items are indications named by the American Society of Clinical Oncology as characteristics of a person who should receive palliative care but not any cancer-directed therapy. These characteristics may be generally applicable to other disease conditions besides cancer. Palliative care is a term derived from Latin palliare, "to cloak.

It is focused on providing people with relief from the symptoms, pain and stress of a serious illness—whatever the prognosis.

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A World Health Organization statement [16] describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

In addition, the rapidly growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness. While palliative care may seem to offer a broad range of services, the goals of palliative treatment are concrete: relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, a support system to help the individual live as actively as possible and a support system to sustain and rehabilitate the individual's family.

Starting in in the United States, palliative medicine is now a board certified sub-speciality of internal medicine with specialised fellowships for physicians who are interested in the field. In the United States, a distinction should be made between palliative care and hospice care.

Hospice services and palliative care programs share similar goals of providing symptom relief and pain management. Hospice care focuses on five topics: communication, collaboration, compassionate caring, comfort, and cultural spiritual care. The end of life treatment in hospice differs from that in hospitals because the medical and support staff are specialized in treating only the terminally ill.

This specialization allows for the staff to handle the legal and ethical matters surrounding death more thoroughly and efficiently with survivors of the patient. Hospice comfort care also differentiates because patients are admitted to continue managing discomfort relief treatments while the terminally ill receiving comfort care in a hospital are admitted because end-of-life symptoms are poorly controlled or because current outpatient symptom relief efforts are ineffective.

Hospice is a type of care involving palliation without curative intent. Usually, it is used for people with no further options for curing their disease or in people who have decided not to pursue further options that are arduous , likely to cause more symptoms, and not likely to succeed. Hospice care under the Medicare Hospice Benefit requires that two physicians certify that a person has less than six months to live if the disease follows its usual course. This does not mean, though, that if a person is still living after six months in hospice he or she will be discharged from the service.

The philosophy and multi-disciplinary team approach are similar with hospice and palliative care, and indeed the training programs and many organizations provide both. Outside the United States there is generally no such division of terminology or funding, and all such care with a primarily palliative focus, whether or not for people with a terminal illness, is usually referred to as palliative care. Outside the United States the term hospice usually refers to a building or institution which specializes in palliative care, rather than to a particular stage of care progression.

Such institutions may predominantly specialize in providing care in an end-of-life setting; but they may also be available for people with other specific palliative care needs. The average time between the admission of a terminally ill patient and death is 7. The average length of stay at a hospice house from admission to death is about 48 hours. Although many individuals die at home or in a care facility, the number of deaths that occurred in a hospital setting increased from to Hospitals are able to accommodate the demand for acute medical attention as well as education and supportive therapies for the families of their loved ones.

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Within hospital settings, there is an increasing shortage of board-certified palliative care specialists. This shortage results in the responsibility of comfort care falling on the shoulders of other individuals. A method for the assessment of symptoms in people admitted to palliative care is the Edmonton Symptoms Assessment Scale ESAS , in which there are eight visual analog scales VAS of 0 to 10, indicating the levels of pain , activity, nausea , depression , anxiety , drowsiness , appetite and sensation of well-being , [23] sometimes with the addition of shortness of breath.

Medications used in palliative care can be common medications but used for a different indication based on established practices with varying degrees of evidence. Routes of administration may differ from acute or chronic care, as many people in palliative care lose the ability to swallow. A common alternative route of administration is subcutaneous, as it is less traumatic and less difficult to maintain than intravenous medications.

Other routes of administration include sublingual, intramuscular and transdermal. Medications are often managed at home by family or nursing support. Palliative care interventions in care homes may contribute to lower discomfort for residents with dementia, and to improve family member's views of the quality of care. For many patients, end of life care can cause emotional and psychological distress, contributing to their total suffering.


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  8. Palliative pets can play a role in this last category. In the s, hospice pioneer Cicely Saunders first introduced the term "total pain" to describe the heterogenous nature of pain. Identifying the cause of pain can help guide care for some patients, and impact their quality of life overall.

    Physical pain can be managed using pain medications as long as they do not put the patient at further risk for developing or increasing medical diagnoses such as heart problems or difficulty breathing. Once the immediate physical pain has been dealt with, it is important to remember to be a compassionate and empathetic caregiver that is there to listen and be there for their patients.

    Being able to identify the distressing factors in their life other than the pain can help them be more comfortable. Having a Psychosocial assessment allows the medical team to help facilitate a healthy patient-family understanding of adjustment, coping and support. This communication between the medical team and the patients and family can also help facilitate discussions on the process of maintaining and enhancing relationships, finding meaning in the dying process, and achieving a sense of control while confronting and preparing for death.

    Spirituality is a fundamental component of palliative care. According to the Clinical Practice Guidelines for Quality Palliative Care, spirituality is a "dynamic and intrinsic aspect of humanity Palliative care for children and young people is an active and total approach to care, from the point of diagnosis, throughout the child's life, death and beyond.

    It embraces physical, emotional, social and spiritual elements and focuses on the enhancement of quality of life for the child or young person, and support for the whole family. It includes the management of distressing symptoms, provision of short breaks, end of life care and bereavement support. Palliative care can be introduced at any point throughout a child's life; it is completely individual. Some children may require palliative care from birth, others only as their condition deteriorates. Families may also vary as to whether they wish to pursue treatments aimed to cure or significantly prolong life.

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    In practice, palliative care should be offered from diagnosis of a life-limiting condition or recognition that curative treatment for a life-threatening condition is not an option; however, each situation is different and care should be tailored to the child. There are an estimated 49, children and young people in the UK living with a life-threatening or life-limiting condition that may require palliative care services.

    The Paediatric Palliative Care Australia and New Zealand Corporation PPCANZ in conjunction with Palliative Care Australia supports a 'Paediatric Palliative Care' website [40] which provides practical information about paediatric palliative care to families who have a child with a life-limiting illness, as well as information about the people who support them. There is however very little empirical research regarding the support provided to children in palliative care.

    Palliative care began in the hospice movement and is now widely used outside of traditional hospice care. Hospices were originally places of rest for travellers in the 4th century. In the 19th century a religious order established hospices for the dying in Ireland and London.

    6 Principles of palliative care

    The modern hospice is a relatively recent concept that originated and gained momentum in the United Kingdom after the founding of St. Christopher's Hospice in It was founded by Dame Cicely Saunders , widely regarded as the founder of the modern hospice movement. Dame Cicely Saunders, went to St.

    After working with the terminally ill she went and became a doctor in so that she could start her own hospice. Cicely Saunders then opened her own hospice after she saw all of the terminally ill patients that she nursed in excruciating pain because their pain was not being managed like it should have been. In the UK in there were just under 1, hospice services consisting of inpatient units for adults with 3, beds, 33 inpatient units for children with beds, home care services, hospice at home services, day care services and hospital teams.

    These services together helped over , people in and Hospice in the United States has grown from a volunteer-led movement to a significant part of the health care system.

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    In around 1. Most hospice care is delivered at home. Hospice care is also available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons. The program evolved into The Harry R. Since then there has been a dramatic increase in hospital-based palliative care programs, now numbering more than 1, Eighty percent of US hospitals with more than beds have a program. A widely cited report in of a randomized controlled trial with patients found that palliative care delivered to patients and their caregivers at home improved satisfaction with care while decreasing medical service use and the cost of care.

    Patients may prefer to be at home when dying or receiving care. Unfortunately, for a large number of patients this does not happen. A systematic review showed that home palliative care allows more people to die at home. The results of a study in The New England Journal of Medicine showed that people with lung cancer who received early palliative care in addition to standard oncologic care experienced less depression, increased quality of life and survived 2.

    In , The Joint Commission an independent, not-for-profit organization that accredits and certifies thousands of health care organizations and programs in the United States began an Advanced Certification Program for Palliative Care that recognizes hospital inpatient programs. In order to obtain this certification, a hospital must show superior care and enhancement of the quality of life for people with serious illness.

    The first pan- European center devoted to improving palliative care and end-of-life care was established in Trondheim , Norway in Families of persons who get a referral to palliative care during a hospitalization incur less costs than people with similar conditions who do not get a palliative care referral.