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Summary The development of a new inpatient hospice unit provided a valuable opportunity to consider ways in which nursing care is defined and documented. Three values which the authors felt [...]

This paper reports findings from visits to palliative care settings and research units in the UK, Belgium and the Netherlands. The aim was to learn about clinicians' (both nurses and doctors) and academic researchers' understandings and experiences of palliative sedation for managing suffering at the end of life, and their views regarding its clinical, ethical and social implications. The project was linked to two larger studies of technologies used in palliative care. Eleven doctors, 14 nurses and 10 researchers took part in informal interviews. Relevant reports and papers from the academic, clinical and popular press were also collected from the three countries. The study took place in a context in which attention has been drawn towards palliative sedation by the legalisation of euthanasia in the Netherlands and Belgium, and by the reexamination of the legal position on assisted dying in the UK. In this context, palliative sedation has been posited by some as an alternative path of action. We report respondents' views under four headings: understanding and responding to suffering; the relationship between palliative sedation and euthanasia; palliative sedation and artificial hydration: and risks and uncertainties in the clinician-patient/family relationship. We conclude that the three countries can learn from one another about the difficult issues involved in giving compassionate care to those who are suffering immediately before death. Future research should be directed at enabling dialogue between countries: this has already been shown to open the door to the development of improved palliative care and to enhance respect for the different values and histories in each. Keywords: Europe; Palliative care; End-of-life care; Euthanasia; UK; Belgium; The Netherlands

The case of an 89 years old woman is used to describe the challenges of recognizing frailty in clinical practice, common problems, symptoms that frail older adults experience, and the approaches to these issues that clinicians might incorporate into their practices. It is suggested that the application of multidisciplinary, team-based palliative approaches and of up-to-date geriatrics knowledge is beneficial for treating these patients due to the complexity of their social and medical needs.

Abstract A hospital palliative care team () aims to provide specific advice, information and support for people with cancer in partnership with hospital consultants and ward teams. To evaluate whether [...]

Abstract Health promotion is a discipline that, through education and support, helps people to change their lifestyle to move toward a state of optimal health. It may seem contradictory to [...]

CANCER IS ONE of the biggest killers in the country. To tackle the disease, the government launched its NHS Cancer Plan (Department of Health 2000), which set out a comprehensive [...]

Byline: Laurent Holzapfel (1), Guy Demingeon (1), Bonnavy Piralla (1), Loic Biot (1), Brigitte Nallet (1) Keywords: Ethics Critical care Palliative treatment Withholding Withdrawing Terminal care Abstract: Abstract Objective. To describe a four-step protocol for withholding and withdrawal of life support (WH/WDLS) in intensive care unit (ICU) terminal patients. Design. Observational study. Setting. A 10-bed ICU of a general hospital. Patients. Eighty-three patients out of 475 consecutive patients admitted over a 1 year period had WH/WDLS. Interventions. The healthcare team chose a pattern of treatment limitation on a four-step protocol for every patient every day. There were four alternatives: group 1: no limitation of care group 2: patient designated do not resuscitate (DNR) and pressors limited to dopamine at a maximum dose of 20 Aug/kg per min others therapies were continued group 3: active withdrawal of all therapy except comfort care, i.e., the patient continued to receive nursing, sedation/analgesia, hydration and mechanical ventilation with FIO.sub.2=0.21 and no positive end-expiratory pressure (PEEP). Sedation was adjusted to Ramsay 3--4. The group 4 was treated the same as group 3 except that minute ventilation was 5 l/min and sedation/analgesia adjusted to Ramsay 6. WH/WDLS was performed only if the full ICU staff and all family members agreed with the procedure. WH/WDLS was documented in the patient's chart. Results. Withholding and withdrawal of life support was performed in 83 patients (17%): 25 patients in group 2 (15 deaths), 36 patients in group 3 (36 deaths) and 22 patients in group 4 (22 deaths). Finally, 73 patients died after WH/WDLS. ICU stay was 10+-17 days, time from admission to WH/WDLS was 184+407 h and time from WH/WDLS to death was 64+-84 h. Conclusion. This four-step protocol may promote medical decision making on end-of-life care. Author Affiliation: (1) Service de reanimation, Centre Hospitalier, Route de Paris, 01012 Bourg en Bresse, France Article History: Received Date: 03/09/2001 Accepted Date: 14/05/2002 Article note: Electronic Publication

All palliative care should focus on maintaining the dying person's dignity. Tips are provided for doctors and nurses who want to provide dignity-conserving care, including specific questions they can ask patients., The basic tenets of palliative care may be summarized as the goal of helping patients to die with dignity. The term "dignity" provides an overarching framework that may guide the physician, patient, and family in defining the objectives and therapeutic considerations fundamental to end-of-life care. Dignity-conserving care is care that may conserve or bolster the dignity of dying patients. Using segments of interviews with a patient with advanced lung cancer, his wife, and his palliative care physician, this article illustrates and explores various aspects of dignity-conserving care and the model on which it is based. Dignity-conserving care offers an approach that clinicians can use to explicitly target the maintenance of dignity as a therapeutic objective and as a principle of bedside care for patients nearing death.