The document discusses ethics of end-of-life care. It begins by defining end-of-life care and palliative care. It then outlines the four guiding ethical principles of clinical integrity, beneficence, autonomy, and justice/non-maleficence. The document discusses some key ethical dilemmas at the end of life including advance directives, surrogate decision makers, and refusal of treatment. It also discusses controversial issues like euthanasia and physician-assisted suicide.
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
This document discusses various topics related to end of life care, including palliative care, hospice care, end of life in the ICU, common symptoms at end of life, and their management. It addresses pain management, including assessment of pain and the WHO pain ladder. It also discusses management of other common symptoms like nausea/vomiting, dyspnea, fatigue, anorexia/cachexia, depression, delirium, and euthanasia. Important court cases related to passive euthanasia in India and other countries are also summarized.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Withholding and withdrawal of medical therapies Jelisa1975
This document discusses the complex ethical and legal issues surrounding the withholding or withdrawal of life-sustaining medical treatments. It addresses key definitions, considerations regarding patient autonomy and provider responsibilities, relevant policies and acts, and two case studies that illustrate common dilemmas providers may face. Overall, the document stresses the importance of open communication, compassion, and ensuring the dignity and self-determination of the patient in all end-of-life medical decisions and care.
This document provides information about advanced directives. It defines an advanced directive as a legal document that specifies a person's wishes for medical treatment if they become unable to make decisions. It discusses the importance of advanced directives for patients, families, and physicians. It also describes different types of advanced directives like living wills, medical powers of attorney, and do not resuscitate orders.
Ethics at the End of Life and Introduction to Hospice and Palliative Care for Medical Students. Exploration of feeding tubes, code status, when to stop chemo. Discusses cases and the ethical principles and values that are the basis for disagreement in care and what to do when there is a conflict in ethical principles themselves. Also provides an introduction to decisions of last resort including physician aid in dying, palliative sedation and voluntary refusal of nutrition and hydration.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
This document discusses various topics related to end of life care, including palliative care, hospice care, end of life in the ICU, common symptoms at end of life, and their management. It addresses pain management, including assessment of pain and the WHO pain ladder. It also discusses management of other common symptoms like nausea/vomiting, dyspnea, fatigue, anorexia/cachexia, depression, delirium, and euthanasia. Important court cases related to passive euthanasia in India and other countries are also summarized.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Withholding and withdrawal of medical therapies Jelisa1975
This document discusses the complex ethical and legal issues surrounding the withholding or withdrawal of life-sustaining medical treatments. It addresses key definitions, considerations regarding patient autonomy and provider responsibilities, relevant policies and acts, and two case studies that illustrate common dilemmas providers may face. Overall, the document stresses the importance of open communication, compassion, and ensuring the dignity and self-determination of the patient in all end-of-life medical decisions and care.
This document provides information about advanced directives. It defines an advanced directive as a legal document that specifies a person's wishes for medical treatment if they become unable to make decisions. It discusses the importance of advanced directives for patients, families, and physicians. It also describes different types of advanced directives like living wills, medical powers of attorney, and do not resuscitate orders.
Advanced directives are legal documents that specify a person's medical wishes in case they become unable to make decisions themselves. There are several types, including living wills, durable power of attorney, and health care proxies. A living will outlines preferences for life-sustaining treatments. A durable power of attorney designates someone to make medical and financial decisions. Health care proxies appoint a surrogate decision maker. The Patient Self-Determination Act protects patient rights regarding advance directives and medical decision making. However, ethical issues can arise regarding competency determinations and disagreements between patients, families and medical staff over treatment plans.
The document discusses end-of-life care, including palliative care, hospice care, and spiritual care. It defines end-of-life care as care for patients with advanced, progressive, and incurable conditions. The goals of end-of-life care are to provide comfort, improve quality of life, and ensure a dignified death. Palliative care focuses on relieving suffering and improving quality of life for patients with serious illnesses, while hospice care provides support to terminally ill patients and their families. Nurses play a key role in providing holistic care to address physical, emotional, and spiritual needs at the end of life.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
This document discusses the principle of nonmaleficence in medical ethics. It defines nonmaleficence as the obligation to not inflict harm, based on the maxim "first, do no harm" from the Hippocratic tradition. The principle helps guide decision-making around issues like killing, treatment withdrawal, and use of ordinary vs extraordinary measures. It distinguishes nonmaleficence from beneficence, provides examples of nonmaleficence, and discusses practical applications like withholding/withdrawing treatment and ordinary/extraordinary measures.
This document discusses quality of life and end-of-life care. It defines quality of life as a multidimensional concept involving physical, mental, emotional, and social well-being. Palliative care aims to improve quality of life for terminally ill patients through pain management and other support. Euthanasia involves intentionally ending a life to relieve suffering, and can be voluntary, non-voluntary, or involve physician assistance. Quality end-of-life care focuses on pain relief, patient comfort, and allowing time with family.
This document discusses several ethical principles related to terminal illness: respect for autonomy, beneficence, non-maleficence, and justice. It notes that physicians must obtain informed consent from competent patients before treatment, even if terminally ill. The principle of beneficence means doing good and helping patients through preserving life, restoring health, relieving suffering and maintaining function. Non-maleficence means avoiding harm. Justice means equitable distribution of medical resources. Ethical decisions in terminal illness are generally made on an individual basis considering these principles.
Euthanasia and physician assisted suicideeliweber1980
This document discusses different types of euthanasia and physician-assisted suicide. It defines active euthanasia as intentionally ending a patient's life, while passive euthanasia involves withholding treatment to allow natural death. Voluntary euthanasia requires patient consent, while involuntary euthanasia does not. Arguments for allowing euthanasia center around patient autonomy and relieving suffering, though critics argue this could lead to a slippery slope and that killing is morally worse than letting die. The document examines philosophical debates on these issues but draws no firm conclusions.
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.
This content clearly explains what is a restraint, types, purpose, indications for using, criteria of using, contraindications & nursing care of a patient on restraint.
The document discusses communication and decision making near the end of life. It provides statistics on hospital deaths and quality of end of life care in Canada. It emphasizes the importance of communication between physicians and patients, and outlines principles for discussions around end of life issues, including assessing understanding and goals, developing care plans, and providing closure.
This document discusses medical consent and its importance. It outlines that consent means voluntary agreement or permission, and is a critical issue and legal/ethical requirement in medical treatment. The document discusses the history of consent principles from the Nuremberg Code to current Medical Council of India guidelines. It describes different types of consent including informed, expressed, implied, advance, and surrogate consent. Key aspects of obtaining proper informed consent from patients are also summarized.
The document outlines the legal rights and responsibilities of patients. It discusses the origins of patient rights in medical codes of ethics. Key patient rights include the right to considerate care, information about diagnosis/treatment, privacy/confidentiality, and refusing to participate in experiments. The document also discusses avenues for filing complaints, such as medical councils, consumer courts, civil courts, and criminal courts. Finally, it lists patient responsibilities like following treatment plans and making prompt payments.
The document discusses several topics related to organ donation including:
- What organ donation is and which organs can be donated including from living or deceased donors.
- The process of post-death organ donation and challenges with organ degradation after death.
- Differences in opt-in vs opt-out donation systems between countries like England and Spain.
- Ethical dilemmas around situations like a donor's wife refusing donation against their wishes or whether heavy drinkers should receive liver transplants.
- Definitions of terms like organ transplant, donor, and medical tourism.
The document outlines patient rights and responsibilities at healthcare facilities. It lists patients' rights to considerate care, information about diagnosis and treatment, privacy and confidentiality, consent for treatment, access to medical records, and understanding of costs. It also describes views of patient rights including access to care, dignity and respect, personal safety, identity of caregivers, communication, and hospital charges. Finally, it lists patient responsibilities such as providing medical history, respecting privacy of others, following rules, and sharing insurance information.
This document discusses the topic of euthanasia from a social work perspective. It defines euthanasia as the painless killing of a patient suffering from an incurable disease. While legal in a few U.S. states, euthanasia is illegal in most countries. The document outlines different types of euthanasia, arguments for and against, effects on patients and families, the perspectives of social workers versus medical personnel, and references studies on dignity at end of life.
Basics of palliative care including symptom management: pain, dyspnea, nausea and constipation; family meetings, goals-of-care, end-of-life care, and artificial nutrition.
Tubing misconnections in critical set up is often a grave error which needs to be addressed well with policies and standard operating procedures. A good understanding of the problem by the team will go a long way in preventing this mishap to ever happen in your team.
The document discusses several ethical principles in healthcare including autonomy, beneficence, non-maleficence, and justice. It also reviews issues around patient competence, capacity, consent and best interests. Guidelines are provided around withdrawing treatment, Do Not Attempt Resuscitation orders, and considering a patient's wishes based on advance directives or views of family members when a patient lacks capacity.
Ethical, moral and legal issues in oncologyManali Solanki
The document discusses end of life care and ethics in oncology nursing. It defines end of life care as treating, comforting, and supporting those living with or dying from chronic life-threatening illnesses. It also discusses the importance of communication, education, and addressing spiritual-psychosocial needs of dying patients and their families. The document outlines several ethical issues that may arise in end of life care, such as medical futility, terminal sedation, euthanasia, physician assisted suicide and advocates respecting patient autonomy.
Dr. Prabhat Ranjan discusses end of life care in India. There is a need to implement palliative care approaches rather than solely curative approaches when prognosis is poor. Physicians fear legal liability for limiting therapies. There are also no clear ethical or legal guidelines around ICU deaths in India. A good death involves controlling physical symptoms, meeting nonphysical needs, dying with dignity in one's chosen place, and not prolonging life artificially. Guidelines for end of life care include discussing prognosis with families, gaining consensus among caregivers, documenting decisions, and providing palliative support to patients and families.
Advanced directives are legal documents that specify a person's medical wishes in case they become unable to make decisions themselves. There are several types, including living wills, durable power of attorney, and health care proxies. A living will outlines preferences for life-sustaining treatments. A durable power of attorney designates someone to make medical and financial decisions. Health care proxies appoint a surrogate decision maker. The Patient Self-Determination Act protects patient rights regarding advance directives and medical decision making. However, ethical issues can arise regarding competency determinations and disagreements between patients, families and medical staff over treatment plans.
The document discusses end-of-life care, including palliative care, hospice care, and spiritual care. It defines end-of-life care as care for patients with advanced, progressive, and incurable conditions. The goals of end-of-life care are to provide comfort, improve quality of life, and ensure a dignified death. Palliative care focuses on relieving suffering and improving quality of life for patients with serious illnesses, while hospice care provides support to terminally ill patients and their families. Nurses play a key role in providing holistic care to address physical, emotional, and spiritual needs at the end of life.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
This document discusses the principle of nonmaleficence in medical ethics. It defines nonmaleficence as the obligation to not inflict harm, based on the maxim "first, do no harm" from the Hippocratic tradition. The principle helps guide decision-making around issues like killing, treatment withdrawal, and use of ordinary vs extraordinary measures. It distinguishes nonmaleficence from beneficence, provides examples of nonmaleficence, and discusses practical applications like withholding/withdrawing treatment and ordinary/extraordinary measures.
This document discusses quality of life and end-of-life care. It defines quality of life as a multidimensional concept involving physical, mental, emotional, and social well-being. Palliative care aims to improve quality of life for terminally ill patients through pain management and other support. Euthanasia involves intentionally ending a life to relieve suffering, and can be voluntary, non-voluntary, or involve physician assistance. Quality end-of-life care focuses on pain relief, patient comfort, and allowing time with family.
This document discusses several ethical principles related to terminal illness: respect for autonomy, beneficence, non-maleficence, and justice. It notes that physicians must obtain informed consent from competent patients before treatment, even if terminally ill. The principle of beneficence means doing good and helping patients through preserving life, restoring health, relieving suffering and maintaining function. Non-maleficence means avoiding harm. Justice means equitable distribution of medical resources. Ethical decisions in terminal illness are generally made on an individual basis considering these principles.
Euthanasia and physician assisted suicideeliweber1980
This document discusses different types of euthanasia and physician-assisted suicide. It defines active euthanasia as intentionally ending a patient's life, while passive euthanasia involves withholding treatment to allow natural death. Voluntary euthanasia requires patient consent, while involuntary euthanasia does not. Arguments for allowing euthanasia center around patient autonomy and relieving suffering, though critics argue this could lead to a slippery slope and that killing is morally worse than letting die. The document examines philosophical debates on these issues but draws no firm conclusions.
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.
This content clearly explains what is a restraint, types, purpose, indications for using, criteria of using, contraindications & nursing care of a patient on restraint.
The document discusses communication and decision making near the end of life. It provides statistics on hospital deaths and quality of end of life care in Canada. It emphasizes the importance of communication between physicians and patients, and outlines principles for discussions around end of life issues, including assessing understanding and goals, developing care plans, and providing closure.
This document discusses medical consent and its importance. It outlines that consent means voluntary agreement or permission, and is a critical issue and legal/ethical requirement in medical treatment. The document discusses the history of consent principles from the Nuremberg Code to current Medical Council of India guidelines. It describes different types of consent including informed, expressed, implied, advance, and surrogate consent. Key aspects of obtaining proper informed consent from patients are also summarized.
The document outlines the legal rights and responsibilities of patients. It discusses the origins of patient rights in medical codes of ethics. Key patient rights include the right to considerate care, information about diagnosis/treatment, privacy/confidentiality, and refusing to participate in experiments. The document also discusses avenues for filing complaints, such as medical councils, consumer courts, civil courts, and criminal courts. Finally, it lists patient responsibilities like following treatment plans and making prompt payments.
The document discusses several topics related to organ donation including:
- What organ donation is and which organs can be donated including from living or deceased donors.
- The process of post-death organ donation and challenges with organ degradation after death.
- Differences in opt-in vs opt-out donation systems between countries like England and Spain.
- Ethical dilemmas around situations like a donor's wife refusing donation against their wishes or whether heavy drinkers should receive liver transplants.
- Definitions of terms like organ transplant, donor, and medical tourism.
The document outlines patient rights and responsibilities at healthcare facilities. It lists patients' rights to considerate care, information about diagnosis and treatment, privacy and confidentiality, consent for treatment, access to medical records, and understanding of costs. It also describes views of patient rights including access to care, dignity and respect, personal safety, identity of caregivers, communication, and hospital charges. Finally, it lists patient responsibilities such as providing medical history, respecting privacy of others, following rules, and sharing insurance information.
This document discusses the topic of euthanasia from a social work perspective. It defines euthanasia as the painless killing of a patient suffering from an incurable disease. While legal in a few U.S. states, euthanasia is illegal in most countries. The document outlines different types of euthanasia, arguments for and against, effects on patients and families, the perspectives of social workers versus medical personnel, and references studies on dignity at end of life.
Basics of palliative care including symptom management: pain, dyspnea, nausea and constipation; family meetings, goals-of-care, end-of-life care, and artificial nutrition.
Tubing misconnections in critical set up is often a grave error which needs to be addressed well with policies and standard operating procedures. A good understanding of the problem by the team will go a long way in preventing this mishap to ever happen in your team.
The document discusses several ethical principles in healthcare including autonomy, beneficence, non-maleficence, and justice. It also reviews issues around patient competence, capacity, consent and best interests. Guidelines are provided around withdrawing treatment, Do Not Attempt Resuscitation orders, and considering a patient's wishes based on advance directives or views of family members when a patient lacks capacity.
Ethical, moral and legal issues in oncologyManali Solanki
The document discusses end of life care and ethics in oncology nursing. It defines end of life care as treating, comforting, and supporting those living with or dying from chronic life-threatening illnesses. It also discusses the importance of communication, education, and addressing spiritual-psychosocial needs of dying patients and their families. The document outlines several ethical issues that may arise in end of life care, such as medical futility, terminal sedation, euthanasia, physician assisted suicide and advocates respecting patient autonomy.
Dr. Prabhat Ranjan discusses end of life care in India. There is a need to implement palliative care approaches rather than solely curative approaches when prognosis is poor. Physicians fear legal liability for limiting therapies. There are also no clear ethical or legal guidelines around ICU deaths in India. A good death involves controlling physical symptoms, meeting nonphysical needs, dying with dignity in one's chosen place, and not prolonging life artificially. Guidelines for end of life care include discussing prognosis with families, gaining consensus among caregivers, documenting decisions, and providing palliative support to patients and families.
Legal and ethical issues in critical care nursingNursing Path
This document discusses several key ethical and legal issues faced by critical care nurses, including informed consent, use of restraints, end-of-life decisions around life-sustaining treatment, organ donation, and resolving ethical problems. It outlines important ethical principles like autonomy, beneficence, and justice. It also addresses issues like medico-legal cases, documentation, and the most concerning ethical issues reported by nurses.
This document provides an overview of end of life care, including defining end of life care and palliative care, identifying the target population, and differentiating between palliative care and hospice care. It discusses factors that influence attitudes towards death, decision making at end of life, barriers to good end of life care, and nursing skills needed to provide palliative care. The goal is to help students understand end of life care and how to support older adults and their families during this process.
Bioethical issues in nursing presents key concepts in bioethics including definitions of bioethics, importance of bioethics in healthcare, and common bioethical situations nurses may encounter. Some key points discussed are:
- Bioethics studies ethical implications of new biological discoveries and advances in fields like genetics and drug research.
- Understanding bioethics is important for nurses due to ever-changing medical policies, patient rights, and new clinical issues.
- Common bioethical issues addressed include reproductive situations like sterilization and abortion, human experimentation, and dealing with infectious diseases like HIV/AIDS.
- Nurses must consider ethical issues around quality of life, end-of-life care, organ
The document discusses New Mexico's End-of-Life Options Act, which legalized medical aid in dying (MAID) as of June 2021. It provides information on qualified individuals, healthcare providers, the capacity determination and prescribing process. Key aspects include that MAID is voluntary for patients and providers. Prescribers can be nurses or physicians assistants, and enrollment in hospice confirms a terminal diagnosis. The law aims to give terminally ill residents control over their end of life by allowing self-administered medication to bring about a peaceful death. Since taking effect, several hospices and healthcare systems have incorporated MAID while respecting conscientious objections.
The document discusses bioethics and outlines several key concepts:
1. It defines bioethics and traces its origins to ancient texts like the Hippocratic Oath. Important modern documents discussed include the Nuremberg Code and Helsinki Declaration.
2. The four cardinal principles of bioethics - autonomy, beneficence, non-maleficence, and justice - are explained. Autonomy and informed consent are emphasized.
3. Physician duties and obligations to patients, colleagues, and society are outlined. Unethical practices are also defined.
4. Case studies on patient autonomy and decision making are discussed in relation to medico-legal and ethical issues.
Dr. Pooja Pandey discusses medical ethics in a document containing several sections. She begins with introductions to medical ethics and bioethics, then discusses the evolution of ethics including landmark documents like the Hippocratic Oath and Nuremberg Code. She explains why ethics has become increasingly important and outlines principles of medical ethics including autonomy, beneficence, confidentiality, non-maleficence, and justice. She also discusses concepts like informed consent, veracity, fidelity, and ethical dilemmas. The document provides an overview of key topics in medical ethics.
Ethical dilemmas are common in neurology practice. Good knowledge of laws and ethics is needed to properly counsel patients and families. The key ethical principles of beneficence, nonmaleficence, respect for autonomy, and justice must be considered. Informed consent is essential. Further debate is required to resolve complex issues like euthanasia, physician-assisted suicide, and resource allocation.
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.
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
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
Now-a-days public are expecting Skills, Knowledge as well as Ethical behaviour from Doctors. This PPT gives the 2 basic principles of Bio-ethics in brief & apt form
Patient care and ethics in ophthalmology Dr. Iddi.pptxIddi Ndyabawe
This document provides an overview of principles of medical ethics as they relate to ophthalmology. It discusses key definitions of ethics and principles, including autonomy, beneficence, non-maleficence, justice, and community. The history of medical ethics is reviewed. Ethical issues in patient care, residency training, and the differences between optometrist and ophthalmologist training are examined. Standards from the International Code of Medical Ethics, Declaration of Helsinki, and codes from the American Academy of Ophthalmology are outlined.
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 provides an overview of medical ethics, informed consent, and advance directives. It discusses key principles of medical ethics including autonomy, beneficence, non-maleficence, and justice. It defines informed consent and its legal and ethical basis, noting it is based on a patient's right to receive information and choose treatment. Exceptions to informed consent requirements are also outlined. Advance directives allow for healthcare decision making according to a patient's wishes if they become incapacitated. Case examples demonstrate how these principles apply to clinical scenarios.
45 minutes of suffering (or Anesthesia Grand Rounds on Palliative Care)Mike Aref
This document summarizes a presentation on palliative care. It discusses:
- The definition and goals of palliative care in alleviating suffering for patients with chronic illnesses
- How palliative care differs from hospice in focusing on symptom management rather than a prognosis of 6 months or less
- The concept of primary palliative care conducted by primary providers to assess physical, psychosocial and spiritual needs
- The importance of establishing goals of care through discussions of patient values, priorities and understanding of their illness
- Strategies for managing common symptoms like pain, depression and dyspnea
Forensic Psychiatry & Ethics in Psychiatry.pptxDR MUKESH SAH
The document discusses several topics related to forensic psychiatry and medical ethics, including forensic psychiatry, medical malpractice, negligent prescription practices, privilege and confidentiality, high-risk clinical situations, and hospitalization procedures. It provides details on the definition and scope of forensic psychiatry. It also explains the key elements needed to prove medical malpractice and discusses areas where negligent prescription practices could result in malpractice suits.
Similar to final ethics of end of life care-2020.pptx (20)
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
The technology uses reclaimed CO₂ as the dyeing medium in a closed loop process. When pressurized, CO₂ becomes supercritical (SC-CO₂). In this state CO₂ has a very high solvent power, allowing the dye to dissolve easily.
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
Travis Hills' Endeavors in Minnesota: Fostering Environmental and Economic Pr...Travis Hills MN
Travis Hills of Minnesota developed a method to convert waste into high-value dry fertilizer, significantly enriching soil quality. By providing farmers with a valuable resource derived from waste, Travis Hills helps enhance farm profitability while promoting environmental stewardship. Travis Hills' sustainable practices lead to cost savings and increased revenue for farmers by improving resource efficiency and reducing waste.
Or: Beyond linear.
Abstract: Equivariant neural networks are neural networks that incorporate symmetries. The nonlinear activation functions in these networks result in interesting nonlinear equivariant maps between simple representations, and motivate the key player of this talk: piecewise linear representation theory.
Disclaimer: No one is perfect, so please mind that there might be mistakes and typos.
dtubbenhauer@gmail.com
Corrected slides: dtubbenhauer.com/talks.html
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
Unlocking the mysteries of reproduction: Exploring fecundity and gonadosomati...AbdullaAlAsif1
The pygmy halfbeak Dermogenys colletei, is known for its viviparous nature, this presents an intriguing case of relatively low fecundity, raising questions about potential compensatory reproductive strategies employed by this species. Our study delves into the examination of fecundity and the Gonadosomatic Index (GSI) in the Pygmy Halfbeak, D. colletei (Meisner, 2001), an intriguing viviparous fish indigenous to Sarawak, Borneo. We hypothesize that the Pygmy halfbeak, D. colletei, may exhibit unique reproductive adaptations to offset its low fecundity, thus enhancing its survival and fitness. To address this, we conducted a comprehensive study utilizing 28 mature female specimens of D. colletei, carefully measuring fecundity and GSI to shed light on the reproductive adaptations of this species. Our findings reveal that D. colletei indeed exhibits low fecundity, with a mean of 16.76 ± 2.01, and a mean GSI of 12.83 ± 1.27, providing crucial insights into the reproductive mechanisms at play in this species. These results underscore the existence of unique reproductive strategies in D. colletei, enabling its adaptation and persistence in Borneo's diverse aquatic ecosystems, and call for further ecological research to elucidate these mechanisms. This study lends to a better understanding of viviparous fish in Borneo and contributes to the broader field of aquatic ecology, enhancing our knowledge of species adaptations to unique ecological challenges.
hematic appreciation test is a psychological assessment tool used to measure an individual's appreciation and understanding of specific themes or topics. This test helps to evaluate an individual's ability to connect different ideas and concepts within a given theme, as well as their overall comprehension and interpretation skills. The results of the test can provide valuable insights into an individual's cognitive abilities, creativity, and critical thinking skills
ESPP presentation to EU Waste Water Network, 4th June 2024 “EU policies driving nutrient removal and recycling
and the revised UWWTD (Urban Waste Water Treatment Directive)”
3. End of life care (EOL)
• EOL: is the care that helps those with advanced, progressive,
incurable illness to live as well as possible until they die.
• It enables the supportive and palliative care needs of both patient
and family to be identified and met throughout the last phase of life
and into bereavement. It includes management of pain & other
symptoms and provision of psychological, social, spiritual and
practical support.
4. Agenda:
• The 4 guiding ethical principles
• What is Palliative care?
• Ethical dilemmas at the end of life
Advance directives
Surrogate decision makers
Refusal of treatment
• Euthanasia
• Physician assisted suicide
5. Ethics
• The discipline dealing with what is good and bad, and with moral duty
and obligation.
6. Medical ethics
• A system of moral principles that apply values and judgements to the
practice of medicine.
10. Clinical Integrity-
My relationship with my profession
• How do we make a care plan when we are
still uncertain about the diagnosis or
prognosis but need to act now?
• What care options should be offered?
• What should we do when the patient’s
or family’s goals seem inconsistent
with traditionally recognized goals of
care?
12. Autonomy-
My relationship with the patient
• Does the patient understand what’s wrong?
• What does my patient think is a good
outcome?
• What is my patient’s cultural, religious, or
ethnic point of view?
• Can my patient make decisions?
• Can my patient participate in a complex care
plan or follow-up plan?
• What are my patient’s goals and aspirations?
• What/Who are my patient’s support system?
13. • The right of self determination of the patient (to decide for himself)
either to accept or refuse medical interventions is based on his
values, beliefs, preferences,& cultural and religious aspects.
• Principles of informed decision making:
Providing all the adequate information by the physician
Having the mental capacity/competency of understanding and
choosing
Having the freedom to choose whatever suits him.
14. Competency versus decisional capacity
Competency:
Decided by a court/judge
Typically chronic alteration
Expected to be permanent
Decisional capacity (decision-making capacity):
Decided by physicians
Typically acute
fluctuates
15. • Most patients lose the decision-making capacity in terminal illnesses
• Alternatives in case of patient impaired decisional capacity:
Surrogate/proxy decision maker القرار التخاذ البديل او الوكيل
Advance directives المسبقة الطبية الوصية
17. Let me make my own decisions
Don’t tell
my family
I am dying
Sedate
me
Send me
home to
die
I want
euthanasia
Feed me
until the
end
Resuscitate
me
?
I don’t want
morphine ?
?
19. Beneficence-
My relationship with the outcomes
• Am I fixing what’s wrong?
• Am I effectively managing a disease
process?
• Am I appropriately managing my patient’s
last days?
• Am I simply delaying the inevitable?
• Am I causing harm to my patient? Or
am I worried I’m causing more harm
21. Justice &
Nonmaleficence- My
relationship with others
• Do I owe my patient’s family something?
• Do I owe my colleagues something?
• Is my patient at risk for being hurt, and if so
do I have an obligation to prevent harm?
• Are there conflicts of interest that could harm
my patient or someone else?
• Am I being a good steward of resources?
• Do I owe society or the community something?
22. Agenda:
• The 4 guiding ethical principles
• What is Palliative care?
• Ethical dilemmas at the end of life
Advance directives
Surrogate decision makers
Refusal of treatment
• Euthanasia
• Physician assisted suicide
25. Clinical
Context
Acute Rescue, Fix
Chronic Maintain, Manage
Palliative Alleviate suffering,
Enhance Quality of Life
Life-Sustaining Prolongation
of
biological life
Futile Non-Beneficial
26. • Palliative care is a broad term that includes hospice care
المحتضرين رعايةas well as other care that emphasizes
symptom management & pain relief, in persons with life-
limiting disease, but is not restricted to persons near the end
of life.
27. More on defining palliative care:
• A new specialty of medicine that uses an interdisciplinary team to
manage patients with an advanced illness, in whom the goal of care is
symptom control rather than disease control.
• Or the care of patients who are in an advanced stage of an incurable
illness, with a primary goal of symptom management and mainly
focus on quality of life.
29. Hospice
Hospice is an interdisciplinary program of palliative
and supportive services that is provided both at
home and in institutional settings for persons with
weeks or months to live; so that they may live as fully
and comfortably as possible.
30. Agenda:
• The 4 guiding ethical principles
• What is Palliative care?
• Ethical Dilemmas at the end of life
Advance directives
Surrogate decision makers
Refusal of treatment
• Euthanasia
• Physician assisted suicide
32. Advance care planning for end of life
األجل اقتراب لفترة المسبقة الطبية الرعاية تخطيط
• Planning for future medical care in the event is unable to make his
own decisions
• Should be started early in the course of terminal illness
• Should be updated regularly
• Values and goals are explored and documented
• It is a process, not an event
• Designate a proxy/ surrogate decision maker
عنه نيابة القرار التخاذ بديل او وكيل تعيين
33. Advanced care planning “advance directives”
المسبقة الطبية الوصية
• Instructions of future medical
care
• Designation of decision maker
34. The living will
• A type of advance directives
• It is a legal document used to state certain future health care decisions only
when a person becomes unable to make the decisions and choices on their
own.
• The living will is only used at the end of life if a person is terminally ill (can't
be cured) or permanently unconscious.
• The living will describes the type of medical treatment the person would
WANT or NOT WANT to receive in these situations.
• This applies to treatments including: dialysis, mechanical ventilation,
hydration or artificial nutrition, DNR orders (don’t resuscitate orders; not to
start chest compression, intubation in case of cardiac arrest), use of
palliative care, organ donation.
35. Physician orders for life-sustaining treatment
P.O.L.S.T
• A type of advance directives signed by patient and physician
• Helps prevent unwanted medical interventions, such as CPR.
• Travels with patient across healthcare venues.
36. Proxy/surrogate decision maker
• Is a person who is assigned by the patient himself (in advance) to
make decisions about future medical care when the patient become
unconscious or incapable to decide for himself; mostly a 1st degree
relative.
بالعجز اصابته قبل كتبها وصية فى بنفسه المريض يعينه من هو شخص افضل
• If the patient didn’t previously choose a proxy, the court may choose
for him.
• If the patient has previously mentioned his preferences and wishes to
the physician, his wishes should be fulfilled
37. • The doctor should supply the proxy decision maker with all available
information and inform him to decide depending on:
1. The patient’s previously declared/documented wishes
2. If no previously known wishes; proxy try to decide depending on
what would probably suits the patient’s beliefs, thoughts and
wishes.
3. If the physician finds out that the proxy decision maker is acting
against the beliefs and wishes of the incapacitated patient;
physician should decide for the patient’s BEST INTEREST.
38. Refusal of treatment
• The informed consent المستنيرة الموافقة entails either accepting or
refusing the medical treatment or intervention.
• Either accepting or refusing treatment is one of the patient’s rights
and it is the duty of the physician to fulfil his wishes provided that the
terms of informed consent are satisfied(providing all information,
having mental competence/capacity and freedom to choose).
• Refusal of treatment is justified by the ethical principle of “respect of
autonomy”
39. Ethical dilemmas arise if refusal of treatment
occur in the following cases:
1. Emergency situations that require rapid life saving intervention e.g:
renal dialysis, amputation االطراف احد بتر, emergency surgery.
2. Refusal of life saving blood transfusion for religious reasons يهوة شهود
3. Refusal of life saving treatment of a child, mentally incompetent or
comatose patients by his proxy decision maker. Here, the physician
can act for the patient’s “best interest” against the will of his proxy.
المريض مصلحة جانب الى الوقوف
الموت او الضرر الى ادى اذا جائز غير االسالمية الشريعة فى العالج رفض
"
التهلكة الى بايديكم تلقوا وال
"
البقرة سورة
195
40. Agenda:
• The 4 guiding ethical principles
• What is Palliative care?
• Ethical Dilemmas at the end of life
Advance directives
Surrogate decision makers
Refusal of treatment
• Euthanasia/ Physician assisted suicide
42. Euthanasia
• It is a Greek word: Eu: well
thanantos: death
• Euthanasia literally means “good death” or “soft death” or “death
without suffering”.
• Euthanasia is the painless killing of a person suffering from an
incurable disease.
43. Types of euthanasia
1. Active euthanasia: االيجابى الرحيم القتل
Intentionally administering medications or other interventions by the
physician to cause patient’s death.
االالم رفع اجل من والشفقة الرحمة بدافع المريض لقتل مقصود ارادى ايجابى بعمل القيام هو
قاتلة دوائية جرعة اعطائه مثل عنه والمعاناة
.
2. Passive euthanasia: السلبى الرحيم القتل
Withholding حجب or withdrawing سحب life-sustaining medical treatment
from the patient to let him die.
بالموت بالسماح ايضا ويعرف
..
اجهزة ايقاف مثل للحياة الداعم العالج عن التوقف هو و
طبيعية بصورة الموت بحدوث للسماح التنفس
.
44. 3. Voluntary euthanasia: االرادى الرحيم القتل
To cause patient’s death at the patient’s explicit request and with full
informed consent.
الرادته وتنفيذا لرغبته تحقيقا و المريض طلب على بناء يتم
.
4. Non voluntary euthanasia: االرادى غير الرحيم القتل
To cause patient’s death, while the patient is mentally incompetent
(Alzheimer, dementia), comatose or in children/neonates.
المصاب او الوعى فاقد مثل القرار اتخاذ عن العاجز للمريض بذلك القرار الطبيب يتخذ عندما
المواليد و االطفال لدى او الزهايمر داء او الشيخوخة بعته
.
45. 5. Involuntary euthanasia الالارادى الرحيم القتل
To cause patient’s death, when the patient is competent but without
the patient’s explicit request or informed consent (patient may not
even know).
دون االقل على او القرار اتخاذ على القادر الكفء المريض ارادة ضد الرحيم القتل يتم
علمه بدون حتى او موافقته و رضاه على الحصول
.
46. 6. Physician-assisted suicide: االنتحار على الطبية المساعدة
When a physician provides or prescribes, (but doesn’t administer)
medications or other interventions to a patient (either terminally ill or
not), with understanding that the patient intends to use them to
commit suicide.
يبقى الحياة انهاء فعل ولكن لالنتحار الالزمة الوسائل و المعلومات للمريض الطبيب يوفر
بيد
بنفسه هو ويؤديه نفسه المريض
.
*
االرادى االيجابى الرحيم القتل حول المجتمعات من كثير فى الدائر الجدل يتركز
Voluntary active euthanasia
من متكرر طلب على بناء الموت على المشرف المريض حياة بانهاء الطبيب فيه يقوم الذى
القرار اتخاذ على القادر الكفء المريض
.
47. Ethical debates of euthanasia:
• With:
euthanasia is justified by the right of self determination and respect
of autonomy of patients to choose the suitable time and method to
end their life when it becomes futile الجدوى عديمة
Euthanasia alleviates the pain and suffering of terminally ill incurable
patients.
Supporters of euthanasia asks for legalization of the act of euthanasia
تقنين
(
تجريم عدم
)
الرحيم القتل
Euthanasia and physician assisted suicide are legalized in certain
countries e.g: Netherlands, Switzerland, japan, china & Belgium.
48. Ethical debates of euthanasia:
Against:
Euthanasia is dangerous for many vulnerable groups مستضعفة فئات
that might be coerced على تجبر into requesting euthanasia e.g: very
old, the poor, disabled, handicapped, medically impaired, drug
addicts or AIDS patients.
Threatens the moral integrity of medical profession
Doctors don’t kill
Demolish the public trust in medical profession and destroys doctor
patient relationship.