The document discusses several key ethical issues in palliative care:
- Communication with patients and families is important to guide treatment based on benefits, risks, and patient values and wishes.
- Pain management with opioids does not shorten lives when used for symptom control.
- As death approaches, all care must be reviewed to avoid futile interventions and ensure patient comfort.
- Advance care planning is important so patient values and preferences can guide care if they lose decision-making capacity.
- Ethical principles of beneficence, non-maleficence, autonomy, and justice must be considered in clinical decision making.
Hernia is defined as the protrusion of an organ or tissue through an abnormal opening. Common causes include congenital defects, injury, straining, or obesity. There are several types of hernias including inguinal, hiatal, femoral, and umbilical. Symptoms vary depending on type but may include lumps, pain, or difficulty swallowing. Diagnosis involves physical exam, imaging, and patient history. Treatment is generally surgical repair to return organs to normal position and reinforce weak areas. Post-operative care focuses on pain management, preventing infection, and education on wound healing.
This document discusses stridor, which is a noisy respiration caused by turbulent airflow through a narrowed airway. It defines three types of stridor based on where in the respiratory cycle the noise occurs: inspiratory, expiratory, and biphasic. Common causes of stridor in children include infections like croup as well as foreign objects. Diagnosis involves examining the timing, quality and other characteristics of the noise along with imaging tests to find the specific obstruction. Treatment depends on the underlying cause but may include medications to reduce swelling like steroids or racemic adrenaline to ease breathing.
1) An 11-month-old male infant was admitted to the hospital with pneumonia. He had a history of fever, cough, difficulty breathing, and poor intake. Examination findings included tachycardia, rales in the lung fields, and a chest x-ray confirming bilateral pneumonia.
2) The nursing care plan addressed ineffective airway clearance and elevated temperature. Interventions included respiratory treatments, antipyretics, fluids, and teaching the mother signs and symptoms of pneumonia.
3) The expected outcomes were for the infant to have effective breathing and clear lungs. The family was educated on prevention of future infections like handwashing and avoiding aspiration risks.
This document summarizes a presentation on acute and chronic bronchitis. It begins by defining acute bronchitis as inflammation of the large bronchi caused by bacterial or viral infection. It then compares acute and chronic bronchitis, noting their differences in pathogens, onset, duration, age groups affected, and clinical presentation. The document discusses the epidemiology and risk factors of acute bronchitis. It covers the infectious and non-infectious causes, pathophysiology, clinical presentation, diagnosis, treatment including pharmacological and non-pharmacological approaches, patient education, and prognosis. The presentation aims to provide an overview of acute and chronic bronchitis for healthcare professionals.
This document provides information about the diagnosis and management of gastrointestinal bleeding. It discusses:
1) The aim is to understand GI bleeding and provide proper care to patients. Objectives include defining GI bleeding, identifying upper and lower GI bleeding, understanding causes and symptoms, and recognizing diagnostic tests and treatments.
2) GI bleeding can occur anywhere along the gastrointestinal tract from mouth to anus. Upper GI bleeding makes up 70% of cases and lower GI bleeding 30%. Etiologies, signs, symptoms, diagnostic evaluations, and management are discussed for both upper and lower GI bleeding.
3) Workup may include history, physical exam, blood tests, endoscopy, angiography, and imaging. Management focuses on res
This document discusses esophageal trauma, including:
1) Esophageal injuries can occur from trauma or medical procedures and allow stomach contents to leak into surrounding tissues, potentially causing infection.
2) The esophagus has four layers and passes behind the heart and lungs before connecting to the stomach. Injuries can occur in the cervical, thoracic, or abdominal sections.
3) Symptoms of esophageal trauma include chest pain, vomiting, difficulty swallowing, and shortness of breath. Diagnosis involves imaging tests and ruling out other potential causes of symptoms. Treatment may involve antibiotics, draining fluids, and surgery depending on the severity of the injury.
Hernia is defined as the protrusion of an organ or tissue through an abnormal opening. Common causes include congenital defects, injury, straining, or obesity. There are several types of hernias including inguinal, hiatal, femoral, and umbilical. Symptoms vary depending on type but may include lumps, pain, or difficulty swallowing. Diagnosis involves physical exam, imaging, and patient history. Treatment is generally surgical repair to return organs to normal position and reinforce weak areas. Post-operative care focuses on pain management, preventing infection, and education on wound healing.
This document discusses stridor, which is a noisy respiration caused by turbulent airflow through a narrowed airway. It defines three types of stridor based on where in the respiratory cycle the noise occurs: inspiratory, expiratory, and biphasic. Common causes of stridor in children include infections like croup as well as foreign objects. Diagnosis involves examining the timing, quality and other characteristics of the noise along with imaging tests to find the specific obstruction. Treatment depends on the underlying cause but may include medications to reduce swelling like steroids or racemic adrenaline to ease breathing.
1) An 11-month-old male infant was admitted to the hospital with pneumonia. He had a history of fever, cough, difficulty breathing, and poor intake. Examination findings included tachycardia, rales in the lung fields, and a chest x-ray confirming bilateral pneumonia.
2) The nursing care plan addressed ineffective airway clearance and elevated temperature. Interventions included respiratory treatments, antipyretics, fluids, and teaching the mother signs and symptoms of pneumonia.
3) The expected outcomes were for the infant to have effective breathing and clear lungs. The family was educated on prevention of future infections like handwashing and avoiding aspiration risks.
This document summarizes a presentation on acute and chronic bronchitis. It begins by defining acute bronchitis as inflammation of the large bronchi caused by bacterial or viral infection. It then compares acute and chronic bronchitis, noting their differences in pathogens, onset, duration, age groups affected, and clinical presentation. The document discusses the epidemiology and risk factors of acute bronchitis. It covers the infectious and non-infectious causes, pathophysiology, clinical presentation, diagnosis, treatment including pharmacological and non-pharmacological approaches, patient education, and prognosis. The presentation aims to provide an overview of acute and chronic bronchitis for healthcare professionals.
This document provides information about the diagnosis and management of gastrointestinal bleeding. It discusses:
1) The aim is to understand GI bleeding and provide proper care to patients. Objectives include defining GI bleeding, identifying upper and lower GI bleeding, understanding causes and symptoms, and recognizing diagnostic tests and treatments.
2) GI bleeding can occur anywhere along the gastrointestinal tract from mouth to anus. Upper GI bleeding makes up 70% of cases and lower GI bleeding 30%. Etiologies, signs, symptoms, diagnostic evaluations, and management are discussed for both upper and lower GI bleeding.
3) Workup may include history, physical exam, blood tests, endoscopy, angiography, and imaging. Management focuses on res
This document discusses esophageal trauma, including:
1) Esophageal injuries can occur from trauma or medical procedures and allow stomach contents to leak into surrounding tissues, potentially causing infection.
2) The esophagus has four layers and passes behind the heart and lungs before connecting to the stomach. Injuries can occur in the cervical, thoracic, or abdominal sections.
3) Symptoms of esophageal trauma include chest pain, vomiting, difficulty swallowing, and shortness of breath. Diagnosis involves imaging tests and ruling out other potential causes of symptoms. Treatment may involve antibiotics, draining fluids, and surgery depending on the severity of the injury.
1) The document discusses several key principles in medical ethics including autonomy, beneficence, non-maleficence, and justice as they relate to informed consent and treatment decisions.
2) It examines the concepts of medical negligence, duty of care, standards of care, damages, and proximate cause in medical malpractice cases.
3) It also addresses treatments for incompetent patients, the principles of patient autonomy and medical futility in end-of-life decisions around cardiopulmonary resuscitation.
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
This document discusses several core ethics principles: autonomy, beneficence, nonmaleficence, justice, informed consent, confidentiality, and others. It provides definitions and examples for each principle. Several case studies involving ethical dilemmas in healthcare are also presented, including conflicts between patient/family wishes and physician recommendations for treatment. The document advocates using an ethical decision-making process and calling an ethics consultation to help resolve complex cases.
This document discusses several key topics in medical ethics including:
1. The basic concepts of medical ethics including beneficence, non-maleficence, autonomy, justice, and informed consent.
2. Historical events that shaped modern medical ethics such as the Tuskegee Syphilis Study and the Doctors' Trial at Nuremberg.
3. The role of Institutional Review Boards in ensuring ethical research and protecting human subjects.
4. Common ethical issues in healthcare like end-of-life care, advance directives, withdrawal of life-sustaining treatment, and resolving disagreements between patients/families and physicians.
"This is how i want to die" DPT Study Day 16th September 2011Hospiscare
The document discusses advance care planning (ACP) and its importance in end-of-life care. It defines ACP as a voluntary process where patients discuss future medical treatment preferences with healthcare providers. Key points include:
- ACP allows patients to communicate their values and wishes should they become unable to make decisions later.
- Triggers for initiating ACP include prognosis from chronic illness or a "gut feeling" from clinicians. Sensitive conversations are important.
- Documents like Preferred Priorities of Care and Advance Decisions to Refuse Treatment can record a patient's wishes if properly completed.
- Valid advance decisions must be specific, signed/witnessed, and state they apply even if life is at
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
The document discusses several ethical issues in intensive care, including goals of care, withdrawing vs withholding treatment, medical futility, and do-not-resuscitate orders. It notes that ICU physicians have a responsibility to use medical skills to avoid non-beneficial treatment while allowing natural death. Withdrawing life-sustaining treatment that is not reversing illness is distinguished from active euthanasia.
This document discusses the ethical and legal responsibilities of critical care nurses. It begins by distinguishing between ethical and legal standards, with ethical standards based on principles of right and wrong and legal standards based on written law.
It then outlines some common ethical dilemmas nurses may face including end-of-life decisions, patient care issues, and human rights issues. It also discusses legal decisions around topics like medical documentation, use of restraints, and declaring brain death.
The document provides recommendations for resolving ethical dilemmas and outlines practical principles for ethical decision making including effective communication and determining patient desires. It emphasizes the importance of shared decision making at end-of-life.
This PPT is all about Something that we want to lear an discover new things in life which might be very useful and essential to do something so you can figure out and work on it so you will be able to do it simply great and awesome in life. After downlading the ppt please do not forget to reshare it with your friends families and morel
This document discusses medical ethics and negligence. It begins by introducing medical ethics and its importance. It then outlines key principles of medical ethics like autonomy, beneficence, and confidentiality. The document also discusses ethical codes like the Hippocratic Oath and concepts like informed consent. It defines medical negligence and outlines duties and responsibilities of physicians. Finally, it discusses punishment for misconduct and negligence.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Recommendations for end-of-life care in the intensive care uni.docxdanas19
This document provides recommendations for end-of-life care in the intensive care unit (ICU). It discusses preparing both the patient and family for withdrawal of life-sustaining treatments by clearly explaining what to expect and ensuring pain and suffering are minimized. It also emphasizes the importance of addressing the needs of families through open communication, allowing them to be present and helpful, and providing emotional support. The overarching goal is to integrate palliative care principles to ensure a dignified and comfortable death for patients in the ICU.
Published April 2017
Part of hospital test scenarios, escalation to ethics committee
Patients with a terminal illness who communicate their wish to die to a nurse shall receive appropriate care that is in line with institutional procedures, local laws, and their personal preferences. A nurse should be able to rely on the support of the institution he or she works for in terms of training, clear line of responsibility for such decisions, and unambiguously communicated expectations defined in organizational procedures. Assisted suicide is legal in Switzerland and several other European countries, in several states in the U.S., and in Canada. The mental capacity of the patient has to be considered in addition to locally applicable laws. Medical Power of Attorney is helpful if the patient previously described his or her wishes regarding end-of-life decisions and became incapacitated in the meantime. Financial toxicity, in addition to dubious effectiveness, contributes to the reluctance of some patients to undergo aggressive and invasive therapies. German physician Albert Moll in his book Medical Ethics (1902), argues that aggressive care in incurably ill patients is unethical. Healthcare staff, including nurses, can conscientiously object to assisting with suicide.
This document discusses modern aspects of homeopathy and the importance of diagnosis. It provides background on the author, Dr. Rajneesh Kumar Sharma, and his qualifications. It discusses Hahnemann's views on the value of diagnosis from the 6th and 7th editions of the Organon of Medicine. The document emphasizes that diagnosis is necessary for selecting the correct treatment, medicine, and management plan. It argues that homeopaths should be allowed to use necessary auxiliary measures like oxygen support and fluid administration when treating patients. The Central Council of Homoeopathy confirms homeopaths' right to use supplementation and diagnostic methods.
PerspectiveRedefining Physicians Role in Assisted DyingJulian.docxssuser562afc1
Perspective
Redefining Physicians' Role in Assisted Dying
Julian J.Z. Prokopetz, B.A., and Lisa Soleymani Lehmann, M.D., Ph.D.
N Engl J Med 2012; 367:97-99July 12, 2012
Interview with Dr. Lisa Lehmann on the physician’s role in assisted dying for terminally ill patients. (16:20)
· Listen
· Download
Terminally ill patients spend their final months making serious decisions about medical care and the disposition of their assets after death. Increasingly, they are also choosing to make decisions about the manner and timing of their death, and many are completing advance directives to withhold life-sustaining treatment. A controversial facet of this trend toward a more self-directed dying process is the question of assisted dying — whether patients should have the option of acquiring a lethal dose of medication with the explicit intention of ending their own life.
This practice is generally illegal, but there is a movement toward greater social and legal acceptance. The Netherlands had a long history of court-regulated assisted dying before official legislative recognition, and some Western European countries have followed its lead. Oregon became the first U.S. state to legalize assisted dying when it passed the Death with Dignity Act (DWDA) through a voter referendum in 1997. Since 2008, six states have considered the issue legislatively or judicially; although legalization efforts failed in New Hampshire, Hawaii, New York, and Connecticut, they succeeded in Washington State (through a referendum) and Montana (through a court ruling). Measures based on the DWDA are up for consideration in Pennsylvania and Vermont, and Massachusetts supporters are working toward a ballot measure. Independent governmental commissions in Canada and Britain have recommended legalization, and the Supreme Court of British Columbia recently struck down a national ban on physician-assisted suicide.
Data from places with legal assisted dying have helped allay concerns about potential abuses and patient safety, but a lingering challenge comes from the medical establishment. Many medical professionals are uncomfortable with the idea of physicians playing an active role in ending patients' lives,1 and the American Medical Association (AMA) and various state medical groups oppose legalization. This position is not an insurmountable barrier, however; we propose a system that would remove the physician from direct involvement in the process.
Advances in palliative medicine have produced effective strategies for managing and relieving pain for most terminally ill patients, including the possibility of palliative sedation. Inadequate pain control therefore ranks among the least common reasons that patients in Oregon request lethal medication. Most say that they are motivated by a loss of autonomy and dignity and an inability to engage in activities that give their life meaning.2 Patients in the United States may already decline to receive life-sustaining treatment through advan.
End of life decision making and approaches to issues of futility power point Bernard Freedman
This document summarizes key topics related to end-of-life decision making, including:
1) Ethically sound and legally mandated end-of-life decisions as well as the responsibilities of surrogate decision makers.
2) What constitutes futile care and how to deal with cultural and religious needs in end-of-life care.
3) The importance of documenting end-of-life decisions in the medical record and giving patients and surrogates sufficient information to make informed decisions.
- Advance directives are legal documents that allow patients to specify their end-of-life medical care wishes in advance in case they become unable to communicate their decisions.
- They can be used to refuse life-sustaining treatment or appoint a healthcare agent to make decisions on their behalf if they lose decision-making capacity.
- Having advance directives gives families and medical professionals peace of mind by making a patient's end-of-life wishes clear from the start.
This document discusses informed consent in healthcare. It defines informed consent and its key components, including discussing the treatment plan, risks, benefits, alternatives, and ensuring the patient understands and is free from coercion. The document outlines principles of respecting patient autonomy, doing no harm, acting in their best interest, and fairness. It discusses assessing patient competence and capacity. Special considerations for informed consent in anesthesia are also covered, such as for Jehovah's Witnesses, minors, and pregnant women.
Unit –IV Nursing Management oragnization M,Sc II year 2023.pptxanjalatchi
Organization is aprocess of grouping the necessary responsibilities and activities into workable units, determining the lines of authority and communication and developing patterns of coordination." "It is conscious development of role structures of superior and subordinate, line and staff. "
INTERNATIONAL AND NATIONAL NURSES WEEK SPEECH 12.5.23.pptxanjalatchi
The document discusses the International and National Nurses Week celebration from May 6-12, 2023. It outlines the theme of "Our Nurses. Our Future." and emphasizes protecting, respecting, and valuing nurses. It also remembers Florence Nightingale, the founder of modern nursing. The speech discusses credentialing, privileging, and self-care for physical, mental, and emotional health as important for the nursing profession. It outlines the broad scope and opportunities for nurses in India and globally.
More Related Content
Similar to ETHICAL ISSUE IN PALLIATIVE CARE GMCH.pptx
1) The document discusses several key principles in medical ethics including autonomy, beneficence, non-maleficence, and justice as they relate to informed consent and treatment decisions.
2) It examines the concepts of medical negligence, duty of care, standards of care, damages, and proximate cause in medical malpractice cases.
3) It also addresses treatments for incompetent patients, the principles of patient autonomy and medical futility in end-of-life decisions around cardiopulmonary resuscitation.
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
This document discusses several core ethics principles: autonomy, beneficence, nonmaleficence, justice, informed consent, confidentiality, and others. It provides definitions and examples for each principle. Several case studies involving ethical dilemmas in healthcare are also presented, including conflicts between patient/family wishes and physician recommendations for treatment. The document advocates using an ethical decision-making process and calling an ethics consultation to help resolve complex cases.
This document discusses several key topics in medical ethics including:
1. The basic concepts of medical ethics including beneficence, non-maleficence, autonomy, justice, and informed consent.
2. Historical events that shaped modern medical ethics such as the Tuskegee Syphilis Study and the Doctors' Trial at Nuremberg.
3. The role of Institutional Review Boards in ensuring ethical research and protecting human subjects.
4. Common ethical issues in healthcare like end-of-life care, advance directives, withdrawal of life-sustaining treatment, and resolving disagreements between patients/families and physicians.
"This is how i want to die" DPT Study Day 16th September 2011Hospiscare
The document discusses advance care planning (ACP) and its importance in end-of-life care. It defines ACP as a voluntary process where patients discuss future medical treatment preferences with healthcare providers. Key points include:
- ACP allows patients to communicate their values and wishes should they become unable to make decisions later.
- Triggers for initiating ACP include prognosis from chronic illness or a "gut feeling" from clinicians. Sensitive conversations are important.
- Documents like Preferred Priorities of Care and Advance Decisions to Refuse Treatment can record a patient's wishes if properly completed.
- Valid advance decisions must be specific, signed/witnessed, and state they apply even if life is at
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
The document discusses several ethical issues in intensive care, including goals of care, withdrawing vs withholding treatment, medical futility, and do-not-resuscitate orders. It notes that ICU physicians have a responsibility to use medical skills to avoid non-beneficial treatment while allowing natural death. Withdrawing life-sustaining treatment that is not reversing illness is distinguished from active euthanasia.
This document discusses the ethical and legal responsibilities of critical care nurses. It begins by distinguishing between ethical and legal standards, with ethical standards based on principles of right and wrong and legal standards based on written law.
It then outlines some common ethical dilemmas nurses may face including end-of-life decisions, patient care issues, and human rights issues. It also discusses legal decisions around topics like medical documentation, use of restraints, and declaring brain death.
The document provides recommendations for resolving ethical dilemmas and outlines practical principles for ethical decision making including effective communication and determining patient desires. It emphasizes the importance of shared decision making at end-of-life.
This PPT is all about Something that we want to lear an discover new things in life which might be very useful and essential to do something so you can figure out and work on it so you will be able to do it simply great and awesome in life. After downlading the ppt please do not forget to reshare it with your friends families and morel
This document discusses medical ethics and negligence. It begins by introducing medical ethics and its importance. It then outlines key principles of medical ethics like autonomy, beneficence, and confidentiality. The document also discusses ethical codes like the Hippocratic Oath and concepts like informed consent. It defines medical negligence and outlines duties and responsibilities of physicians. Finally, it discusses punishment for misconduct and negligence.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
Recommendations for end-of-life care in the intensive care uni.docxdanas19
This document provides recommendations for end-of-life care in the intensive care unit (ICU). It discusses preparing both the patient and family for withdrawal of life-sustaining treatments by clearly explaining what to expect and ensuring pain and suffering are minimized. It also emphasizes the importance of addressing the needs of families through open communication, allowing them to be present and helpful, and providing emotional support. The overarching goal is to integrate palliative care principles to ensure a dignified and comfortable death for patients in the ICU.
Published April 2017
Part of hospital test scenarios, escalation to ethics committee
Patients with a terminal illness who communicate their wish to die to a nurse shall receive appropriate care that is in line with institutional procedures, local laws, and their personal preferences. A nurse should be able to rely on the support of the institution he or she works for in terms of training, clear line of responsibility for such decisions, and unambiguously communicated expectations defined in organizational procedures. Assisted suicide is legal in Switzerland and several other European countries, in several states in the U.S., and in Canada. The mental capacity of the patient has to be considered in addition to locally applicable laws. Medical Power of Attorney is helpful if the patient previously described his or her wishes regarding end-of-life decisions and became incapacitated in the meantime. Financial toxicity, in addition to dubious effectiveness, contributes to the reluctance of some patients to undergo aggressive and invasive therapies. German physician Albert Moll in his book Medical Ethics (1902), argues that aggressive care in incurably ill patients is unethical. Healthcare staff, including nurses, can conscientiously object to assisting with suicide.
This document discusses modern aspects of homeopathy and the importance of diagnosis. It provides background on the author, Dr. Rajneesh Kumar Sharma, and his qualifications. It discusses Hahnemann's views on the value of diagnosis from the 6th and 7th editions of the Organon of Medicine. The document emphasizes that diagnosis is necessary for selecting the correct treatment, medicine, and management plan. It argues that homeopaths should be allowed to use necessary auxiliary measures like oxygen support and fluid administration when treating patients. The Central Council of Homoeopathy confirms homeopaths' right to use supplementation and diagnostic methods.
PerspectiveRedefining Physicians Role in Assisted DyingJulian.docxssuser562afc1
Perspective
Redefining Physicians' Role in Assisted Dying
Julian J.Z. Prokopetz, B.A., and Lisa Soleymani Lehmann, M.D., Ph.D.
N Engl J Med 2012; 367:97-99July 12, 2012
Interview with Dr. Lisa Lehmann on the physician’s role in assisted dying for terminally ill patients. (16:20)
· Listen
· Download
Terminally ill patients spend their final months making serious decisions about medical care and the disposition of their assets after death. Increasingly, they are also choosing to make decisions about the manner and timing of their death, and many are completing advance directives to withhold life-sustaining treatment. A controversial facet of this trend toward a more self-directed dying process is the question of assisted dying — whether patients should have the option of acquiring a lethal dose of medication with the explicit intention of ending their own life.
This practice is generally illegal, but there is a movement toward greater social and legal acceptance. The Netherlands had a long history of court-regulated assisted dying before official legislative recognition, and some Western European countries have followed its lead. Oregon became the first U.S. state to legalize assisted dying when it passed the Death with Dignity Act (DWDA) through a voter referendum in 1997. Since 2008, six states have considered the issue legislatively or judicially; although legalization efforts failed in New Hampshire, Hawaii, New York, and Connecticut, they succeeded in Washington State (through a referendum) and Montana (through a court ruling). Measures based on the DWDA are up for consideration in Pennsylvania and Vermont, and Massachusetts supporters are working toward a ballot measure. Independent governmental commissions in Canada and Britain have recommended legalization, and the Supreme Court of British Columbia recently struck down a national ban on physician-assisted suicide.
Data from places with legal assisted dying have helped allay concerns about potential abuses and patient safety, but a lingering challenge comes from the medical establishment. Many medical professionals are uncomfortable with the idea of physicians playing an active role in ending patients' lives,1 and the American Medical Association (AMA) and various state medical groups oppose legalization. This position is not an insurmountable barrier, however; we propose a system that would remove the physician from direct involvement in the process.
Advances in palliative medicine have produced effective strategies for managing and relieving pain for most terminally ill patients, including the possibility of palliative sedation. Inadequate pain control therefore ranks among the least common reasons that patients in Oregon request lethal medication. Most say that they are motivated by a loss of autonomy and dignity and an inability to engage in activities that give their life meaning.2 Patients in the United States may already decline to receive life-sustaining treatment through advan.
End of life decision making and approaches to issues of futility power point Bernard Freedman
This document summarizes key topics related to end-of-life decision making, including:
1) Ethically sound and legally mandated end-of-life decisions as well as the responsibilities of surrogate decision makers.
2) What constitutes futile care and how to deal with cultural and religious needs in end-of-life care.
3) The importance of documenting end-of-life decisions in the medical record and giving patients and surrogates sufficient information to make informed decisions.
- Advance directives are legal documents that allow patients to specify their end-of-life medical care wishes in advance in case they become unable to communicate their decisions.
- They can be used to refuse life-sustaining treatment or appoint a healthcare agent to make decisions on their behalf if they lose decision-making capacity.
- Having advance directives gives families and medical professionals peace of mind by making a patient's end-of-life wishes clear from the start.
This document discusses informed consent in healthcare. It defines informed consent and its key components, including discussing the treatment plan, risks, benefits, alternatives, and ensuring the patient understands and is free from coercion. The document outlines principles of respecting patient autonomy, doing no harm, acting in their best interest, and fairness. It discusses assessing patient competence and capacity. Special considerations for informed consent in anesthesia are also covered, such as for Jehovah's Witnesses, minors, and pregnant women.
Similar to ETHICAL ISSUE IN PALLIATIVE CARE GMCH.pptx (20)
Unit –IV Nursing Management oragnization M,Sc II year 2023.pptxanjalatchi
Organization is aprocess of grouping the necessary responsibilities and activities into workable units, determining the lines of authority and communication and developing patterns of coordination." "It is conscious development of role structures of superior and subordinate, line and staff. "
INTERNATIONAL AND NATIONAL NURSES WEEK SPEECH 12.5.23.pptxanjalatchi
The document discusses the International and National Nurses Week celebration from May 6-12, 2023. It outlines the theme of "Our Nurses. Our Future." and emphasizes protecting, respecting, and valuing nurses. It also remembers Florence Nightingale, the founder of modern nursing. The speech discusses credentialing, privileging, and self-care for physical, mental, and emotional health as important for the nursing profession. It outlines the broad scope and opportunities for nurses in India and globally.
VOTE OF THANKS FOR NURSES DAY WEEK CELEBRATION 8.5.23.pptxanjalatchi
Dr. Anjalatchi Muthukumaran, the Nursing Superintendent and Vice Principal of Era College of Nursing, gives a vote of thanks for the successful celebration of International Nurses Day week from May 6-12, 2023. He thanks the Almighty, the chief guest Mrs. Mary J. Malik, the guest of honour Prof. Abbas Ali Mahdi, Pro-Vice Chancellor Dr. Farzana Mahdi, Principal Dr. Priscilla Samson, faculty, staff, students and all participants for their efforts in organizing the event. He appreciates the anchor committee, technical team, housekeeping staff and class IV workers for their contributions behind the scenes. Finally, he thanks the audience for making
Unit -III Planning and control M.sc II year.pptxanjalatchi
planning and control, often known as production planning and control, are management functions that seek to determine: first, what market demands are stating and second, reconcile how a company can fill those demands through planning and monitoring.
World No Tobacco Day is observed annually on May 31st to raise awareness about the health risks of tobacco use. This year's theme is "Commit to Quit". The World Health Organization started World No Tobacco Day in 1987 to draw attention to the global tobacco epidemic and preventable death and illness caused by tobacco use. Tobacco kills over 8 million people worldwide each year, with over 7 million deaths due to direct tobacco use and around 1.2 million due to secondhand smoke exposure. Large graphic health warnings on tobacco packaging can help persuade smokers to protect non-smokers from secondhand smoke and encourage more people to quit tobacco use. Over 70% of the 1.3 billion tobacco users worldwide lack access to tools that can help them successfully
This document provides information on the Post Basic B.Sc Nursing program at Era University of Health Sciences in Lucknow, India. The 2-year program aims to prepare graduates to assume nursing responsibilities and roles such as manager, teacher, and researcher. The curriculum includes courses in the first year on subjects like microbiology, nutrition, biochemistry, psychology, and various areas of nursing. The second year focuses on courses in community health nursing, mental health nursing, nursing education, administration, and research. The maximum time allowed to complete the program is 4 years. The document then provides detailed syllabus outlines for some of the first year courses, including learning objectives, topics, and assessment methods for each unit.
This document provides a course plan for a Community Health Nursing course at Era College of Nursing. The course is for second year post basic BSc Nursing students and includes 60 hours of theory and 400 hours of practical training. The course aims to help students understand national healthcare systems and participate in healthcare delivery to communities. It covers topics such as community health concepts, family health nursing, health programs and policies in India, community healthcare systems, and the roles of community health nursing personnel. Students will learn through lectures, discussions, visits, and supervised practical work in urban and rural healthcare settings. Their performance will be evaluated through written assignments, reports, and skill assessments.
LIST OF CHAPTER FOR P.B.SC CHN BOOK.docxanjalatchi
This document provides an index for a community health nursing textbook for post-basic B.Sc nursing students. The index outlines 7 units that will be covered in the textbook, including: 1) introduction to community health nursing concepts and principles, 2) family health services and working with families, 3) organization of health services in India, 4) health education, 5) national health programs, 6) epidemiology, and 7) biostatistics and vital statistics. Each unit lists the chapter topics and page numbers that will discuss the content and concepts addressed in that section of the textbook. The index was prepared by the Vice Principal of Era College of Nursing to outline the structure and flow of information in the community health nursing textbook.
This document contains a synopsis proforma for registering dissertation subjects for an M.Sc. in Nursing program. It requests information such as the candidate's name and address, institution, course of study, admission date, proposed topic, and a brief overview of the intended research work. The synopsis proforma outlines the need for the study and provides sections for references, signatures of the guide and co-guide, remarks from the head of department and principal, and confirmation that ethical clearance was obtained if required.
This document outlines the key terms of a lease agreement between John Doe as the tenant and ABC Rentals as the landlord for an apartment located at 123 Main St. The lease is for a period of 12 months beginning January 1st, 2023, and the tenant agrees to pay $1,000 per month in rent. The document details the responsibilities of both parties regarding repairs, guests, noise, parking, and termination of the lease.
Daily ADR Reporting Form April 2023.docxanjalatchi
This document contains two daily adverse drug reaction reporting forms from ERA Lucknow Medical College and Hospital. The first form lists 31 hospital wards and requests information on any adverse drug reactions in each ward including status, signs/symptoms, corrective action, and preventive action. The second form requests the same information for 13 critical care areas. Both forms require the nursing supervisor's report and signature and notes corrective and preventive actions will be taken by the Pharmacy/Therapeutic Committee.
TRAINNING TOPIC FOR ANNUAL SCHEDULE.docxanjalatchi
The document announces an annual training schedule for nursing staff at ERAS LUCKNOW MEDICAL COLLEGE AND HOSPITAL. It will take place every Tuesday from March 18th to June 20th in the hospital's LT venue from 9-10 AM. The training topics cover policies, procedures, and protocols for emergency patient care, infection control, medication safety, blood transfusions, restraints, pain management, medical errors, disaster response, and quality indicators for the emergency department. An attendance sheet is attached for nursing officers, in-charges, supervisors to sign. The training aims to educate healthcare professionals on providing safe, high quality care according to standards and regulations.
This document appears to be an incomplete table or list with column headers for serial number, date, topic, attendees, and remarks, but no data is provided in the columns. The document does not contain enough substantive information to generate a multi-sentence summary.
International Nurses Day will be celebrated on May 3rd, 2023 with the theme "Our Nurses, Our Future". A slogan competition is being organized for nursing staff with rules that entries must be made by individuals on 4 size paper/cardboard, relate to the nurses day theme, and be handmade in Hindi or English using color. The competition is being organized by Dr. Anjalatchi Muthukumaran, Nursing Superintendent at ELMCH.
This document contains a form for screening employees for tuberculosis (TB) at Era Lucknow Medical College and Hospital. The form collects information about an employee's name, address, age, sex, occupation and screens for symptoms of TB like cough, fever, weight loss, appetite changes, chest pain, night sweats, coughing up blood and history of previous TB treatment. It also screens for additional risk factors like diabetes, high blood pressure, cardiac disease, cancer, immunosuppressive therapy and collects information on sputum tests, x-rays or other tests done and notes any additional remarks.
The nursing department at ELMCH in Lucknow, India organized events to celebrate World Glaucoma Day 2023. Nursing students and faculty raised awareness about glaucoma through presentations, posters, and role plays for patients in wards and clinics. The goal was to educate about glaucoma's incidence, causes, symptoms, diagnosis, treatment and prevention. World Glaucoma Week from March 12-18 aims to spread understanding of early glaucoma detection, as early detection improves treatment outcomes and prevents blindness from this irreversible disease.
REPORT ON WORLD AIDS DAY 2022 CELEBRATION AT ELMCH.docxanjalatchi
The nursing department at ERA LUCKNOW MEDICAL COLLEGE AND HOSPITAL organized activities to mark World AIDS Day 2022 with the theme of "Equalize". Nursing students educated others about HIV/AIDS through charts, posters, and speeches covering causes, symptoms, treatment and prevention of AIDS. They also performed role plays in hospital wards and outpatient departments to raise awareness.
REPORT OF WORLD TUBERCLOSIS DAY 2023.docxanjalatchi
The nursing department at ELMCH in Lucknow, India organized activities to celebrate World Tuberculosis Day 2023 with the theme "Yes! We can end TB!". Nursing students and faculty raised awareness about TB through charts, posters, presentations and role plays for patients in wards and the outpatient department. The goal of World TB Day 2023 is to promote leadership and investments to accelerate recommendations, innovations, and multi-sectoral cooperation to end the TB epidemic. Tuberculosis is a treatable lung disease that spreads through the air and the day aims to increase awareness.
NURSING OFFICER EXAM ON MCQ MODEL PAPER.docxanjalatchi
This document contains details for a nursing officer exam, including the candidate's name, age, qualifications, and exam date and timing. The exam consists of multiple choice questions testing knowledge of medical acronyms and abbreviations as well as identification of medical instruments.
International nurses week celebration 13.5 PPT.pptxanjalatchi
The document summarizes the events held from May 6-12 to celebrate International Nurses Week at ELMCH Era University. Various competitions were held including slogan, poster, essay writing, rangoli, painting, nursing care plan presentations. Winners were recognized in each category, with first place going to Reeta TBC for painting/slogan, Pushpa kanchan's team from NICU for the essay competition, and Shilpi Yadav from TBC for the rangoli competition. The celebration concluded on May 12th with ward competitions recognizing top performing wards.
Discover the benefits of outsourcing SEO to Indiadavidjhones387
"Discover the benefits of outsourcing SEO to India! From cost-effective services and expert professionals to round-the-clock work advantages, learn how your business can achieve digital success with Indian SEO solutions.
HijackLoader Evolution: Interactive Process HollowingDonato Onofri
CrowdStrike researchers have identified a HijackLoader (aka IDAT Loader) sample that employs sophisticated evasion techniques to enhance the complexity of the threat. HijackLoader, an increasingly popular tool among adversaries for deploying additional payloads and tooling, continues to evolve as its developers experiment and enhance its capabilities.
In their analysis of a recent HijackLoader sample, CrowdStrike researchers discovered new techniques designed to increase the defense evasion capabilities of the loader. The malware developer used a standard process hollowing technique coupled with an additional trigger that was activated by the parent process writing to a pipe. This new approach, called "Interactive Process Hollowing", has the potential to make defense evasion stealthier.
Gen Z and the marketplaces - let's translate their needsLaura Szabó
The product workshop focused on exploring the requirements of Generation Z in relation to marketplace dynamics. We delved into their specific needs, examined the specifics in their shopping preferences, and analyzed their preferred methods for accessing information and making purchases within a marketplace. Through the study of real-life cases , we tried to gain valuable insights into enhancing the marketplace experience for Generation Z.
The workshop was held on the DMA Conference in Vienna June 2024.
Ready to Unlock the Power of Blockchain!Toptal Tech
Imagine a world where data flows freely, yet remains secure. A world where trust is built into the fabric of every transaction. This is the promise of blockchain, a revolutionary technology poised to reshape our digital landscape.
Toptal Tech is at the forefront of this innovation, connecting you with the brightest minds in blockchain development. Together, we can unlock the potential of this transformative technology, building a future of transparency, security, and endless possibilities.
3. In those with life-threatening disease, prognosis is
unpredictable. Communication with the patient and family
must guide the clinician, always weighing up the benefits
against the risks and burdens of any intervention, and
recognizing when interventions are futile in the face of
irreversible deterioration.
There is no evidence that patients’ lives are shortened
when opioids and other drugs are used to control pain and
other symptoms, which challenges the usual examples for
double effect (having good and bad consequences) as
given in many standard textbooks.
Some patients make advance decisions to refuse
treatment, in the event of losing decision-making
capacity.
4. Ethical issues in palliative care often arise because of concerns
about how much and what kind of care make sense for someone
with a limited life expectancy.There is often conflict between
clinicians, nurses, other health care team members, patients, and
family members about what constitutes appropriate care,
particularly as patients approach death.
This topic will discuss ethical issues in palliative care. Other issues
regarding the legal aspects of end-of-life care, advance care
planning, how to approach requests for potentially inappropriate
and futile therapies, and discussing goals of care are discussed
separately. In addition, issues related to specific symptoms for the
patient in palliative care and/or at the end of life are discussed
separately.
5.
6.
7.
8. Caring for patients nearing the end of their
life poses many challenges as professionals
strive to make decisions that are morally
justified.Where the wishes of patients,
relatives and professionals conflict, and
where care is limited by the scarcity of
resources, it will often be impossible to
satisfy all demands.
9.
10.
11.
12. Four ethical principles (non-maleficence,
beneficence, respect for autonomy and
justice) are core tenets for clinical decision-
making, ensuring important factors have not
been overlooked.
Decisions reached can then be morally
justified, although principles may conflict,
leaving professionals to judge the ultimate
course of action.
13.
14.
15.
16.
17.
18.
19. Many patients lose the capacity to make
decisions about their management at some
stage in their disease although this usually is in
the last hours of life. When patients have
expressed their wishes for future care before
their condition deteriorated, it is easier to
respect their autonomy.
When formally expressed in writing, the
advance decisions of patients are normally
legally binding for professionals.
Where no discussion has taken place and no
such advance decision exists, it is important to
find out what the patient probably would have
wanted, and it is morally appropriate and
legally justified to provide care in ways that
ensure that obligations of beneficence, non-
maleficence and justice are also fulfilled.
These decisions, taken in the best interest of
the patient as a person, are now described in
the Mental Capacity Act which provides a
framework for making ‘best interests
decisions‘ in such circumstances.
20. Advance care planning (ACP) is a
process that supports adults at
any age or stage of health in
understanding and sharing their
personal values, life goals, and
preferences regarding future
medical care [1].The goal of ACP
is to help ensure that people
receive medical care that is
consistent with their values,
goals, and preferences [1].The
timing and nature of ACP may
vary depending on whether the
person is healthy, has mild to
moderate chronic illness, or has
an advanced life-threatening
illness and is thought likely to die
within the next 12 months [
21.
22. A decision about the appropriateness of attempting CPR
has to be made and reviewed regularly for those with life-
threatening disease as sudden irreversible deterioration
may occur unexpectedlyand, of course, the
pathophysiology of all expected deaths involves a
cardiorespiratory arrest.
For some patients it is very clear that attempting CPR
would be physiologically futile, and risks psychological
distress to other patients, an undignified death for the
patient and calling the cardiac arrest team away from
other duties.
Overall the chances of a patient with advanced malignant
disease surviving a cardiorespiratory arrest are very
limited.
23. The term assisted dying encompasses the concepts of euthanasia (the deliberate
ending of a patient’s life by lethal injection) and physician-assisted suicide (the
deliberate ending of a patient’s life when he takes a lethal cocktail of medications
prescribed by a doctor). Patients who ask for assisted dying usually do so as they
fear what lies ahead, believe they will not have control over their care and often
have witnessed distressing deaths in the past; these requests for
euthanasia/assisted suicide very rarely persist when addressed and discussed
openly.
Although proponents argue that a change in the law would give greater choice
about the place and timing of death, this must be balanced against the risks of
short cuts in care and of coercion that a change in the law would bring about for
the many vulnerable patients who already feel burdensome
There are many practical problems with the systems that are supposed to
regulate assisted dying in other countries. Pragmatism suggests that any scrutiny
of clinicians and procedures ought to occur before the death of the patient (not
afterwards as in the Netherlands andOregon)
and that lethal medications should not be left unsupervised to prevent diversion
into the community should the patient die naturally.
24. All clinicians must make difficult decisions about
withholding or withdrawing treatment;
however, they are particularly common when
caring for a patient entering the very terminal
phase, as there are no longer any reversible
causes of his deterioration.
Symptom control and comfort are paramount,
and all interventions must further this goal.
Interventions that do not contribute to comfort
and are not effective at prolonging life are, by
definition, futile and should cease
25. Decisions to withdraw treatments must be
explained to relatives and carers, who may
otherwise interpret that it was the lack of these
measures that caused death (rather than the
underlying disease).7
They may also feel that professionals are ‘giving
up’ on the patient, so it is crucial to explain the
importance of ongoing comfort measures and
that although priorities may have changed, the
patient’s needs are still at the forefront of care.
26. The doctrine of double effect describes best practice when
balancing the potential benefits of a therapeutic intervention with
the known burdens and possible risks, distinguishing between
intended outcomes (the beneficial effects of an intervention) and
outcomes that can be predicted but are unintended.
Evidence has accrued that the appropriate use of medication, such
as opioids, for symptom control does not shorten life;
double effect is not ‘euthanasia by the backdoor’. However, it
remains important in many areas of clinical practice.
For example, the intended effect of chemotherapy is elimination
of malignant cells, but this benefit must be balanced against the
unintended but predictable risk of death from neutropenic sepsis.
27. Palliative sedation (sometimes termed terminal sedation) is very
occasionally needed for a patient with intractable distress,
often associated with agitation, in the last days and hours of a
patient’s life.The intention of palliative sedation must always be
to relieve symptoms, not to cause or hasten the death of the
patient, and the level of sedation must be maintained as lightly as
is compatible with control of symptoms.
If at all feasible the possibility of palliative sedation should be
discussed with the patient before it is undertaken, and in all
circumstances it should be discussed with relatives and carers.
If the patient is judged to be in the last hours or days of life,
artificial hydration is not necessary (as there will be insufficient
time for dehydration to develop). If the patient appears to have a
longer prognosis, it may be appropriate to commence artificial
hydration by simple measures such as subcutaneous or
intravenous fluids, or even artificially maintained nutrition
28. Advances directives (ADs) are the documents a
person completes while still in possession of
decisional capacity about how treatment decisions
should be made on their behalf in the event they lose
the capacity to make such decisions.They are legal
tools directing treatment decision-making and/or
appointing surrogate decision-makers.Although a
component of advance care planning (ACP), an AD
does not imply that ACP occurred, and thorough ACP
does not always yield ADs (eg, if the patient does not
voice any choices or declines to have their choices
recorded).
29. Caring for patients is a challenging task that requires not only a holistic
view of the patient but also understanding the family, social, legal,
economic, and institutional circumstances surrounding them, especially
as they approach end of life. Unfortunately, there are many myths and
misconceptions about what may or may not be legal in this setting [65].
One legal consideration in the United States is that the Patient Self-
DeterminationAct states that institutions must inform patients of the
right to:
●Participate in and direct their own health care decisions
●Refuse medical or surgical treatment
●Prepare an advance directive (AD)
●Review information on the institutional policies governing these rights
Understanding the legal aspects of end-of-life care will give the
practicing clinician the confidence and freedom to act reasonably.This
topic is discussed in detail separately. (See "Legal aspects in palliative
and end-of-life care in the United States".)
30.
31.
32.
33.
34. One of the most difficult issues raised by the
need to provide palliative care within the
context of limited resources is how to decide
what should and should not be provided.23
The stated aim of palliative care is to
enhance patients’ quality of life.2
One of the difficulties inherent in
attempting to improve the subjective
experiences of patients in an holistic way is
that there is no clear boundary between
what a patient needs and what he might
want.
Attending to both needs and wants will
improve his quality of life. Another difficulty,
which clinical research may resolve over
time, is knowing which interventions are
actually beneficial.2
Without outcome measures, it will be
difficult for those commissioning care to
justify using scarce resources on
interventions which are believed to work but
for which no benefit has been demonstrated.
35. •Good care requires open
discussion about imminent
death and what can be done
to ensure care is given in a
way that enhances the
patient’s dignity
•Opioids and other drugs given
appropriately for symptom
control do not shorten the
patient’s life
•As death approaches, all
aspects of care must be
reviewed to avoid futile
interventions, to ensure the
patient’s needs are met and
that symptoms are well
controlled
36. Till now we have discussed about palliative care
and its issue facing by health care worker and
patients in day today life
Advance care planning (ACP) is an ongoing process in
which patients, their families or other decision-
makers, and their health care providers reflect on
the patient’s goals, values, and beliefs, discuss
how they should inform current and future
medical care, and ultimately use this information
to accurately document the patient’s future
health care choices. (See 'Introduction' above.)
Clinicians bear the responsibility of informing patients
about their prognosis, exploring treatment
options, and helping formulate preferences based
upon a risk-benefit analysis and their values,
whenever circumstances allow. (See 'Advance
care planning' above.)
37. I hope you all understand the about palliative
care and issues facing the health care workers
an patients. I hope you all apply this
knowledge if you handle the patient in future
with confidently .
38. President's Commission for the Study of Ethical Problems in Medicine and Biomedic
al and Behavioral Research. Making health care decisions:The legal and ethical i
mplications of informed consent in the patient-practitioner relationship. United S
tates Government Printing Office;Washington, DC 1982.
Lorenzl S. End of one's life--Decision making between autonomy and
uncertainty. Geriatric Mental Health Care 2013; 1:63.
Roeland E, Cain J, Onderdonk C, et al.When open-ended questions don't work:
the role of palliative paternalism in difficult medical decisions. J Palliat Med 2014;
17:415.
Jacobsen J, Blinderman C, Alexander Cole C, JacksonV. "I'd Recommend …" How
to IncorporateYour Recommendation Into Shared Decision Making for Patients
With Serious Illness. J Pain Symptom Manage 2018; 55:1224.
Billings JA, Churchill LR. Monolithic moral frameworks: how are the ethics of
palliative sedation discussed in the clinical literature? J Palliat Med 2012; 15:709.
BeauchampTL, Childress JF. Principles of Biomedical Ethics, 8th ed, Oxford Unive
rsity Press, 2019.