Lege Artis Medicinae

[“Yesterday no longer exists either…” - End-of-life ethical issues in the care of dementia patients]


OCTOBER 20, 2016

Lege Artis Medicinae - 2016;26(09-10)

[The number of dementia patiens is rising. Most of them die in various institutions, often after many years of care. The long process of nursing and care entails particular ethical requirements that are built primarily on vulnerability, dignity, and dia-logue. The dialogue, however, is often absent from the care of dementia patients. Do we find - as physicians, patients, relatives - that specific time when the patients can still make decisions about end-of-life treatments in a good mental state? Most patients would like to participate in these decisions. Talking about these issues in the early stage of dementia may help in the great emotional burden of family members and caregivers. Therefore the ethical aim is the ad­vance care planning (ACP) of the end-of-life treatments. The study reviews the latest scientific results, with special regard to resources that may be helpful in the course of conversations between doctor and patient on end-of-life preferences, and in the preparation for decision making. ]



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[INTRODUCTION - A crucial challenge for XXI. century health care is the presence of complementary and alternative medicine (CAM). A marked question of professional discourse has been characterizing patient CAM use, yet the attitudes, knowledge, and opinions of physicians have received far less attention. METHODS - This qualitative study involves semi-structured interviews conducted with 45 physicians. The narratives were scrutinized by employing Interpretative Phenomenological Analysis (IPA) via At­las.ti software. RESULTS - The narratives were coded ac­cording to attitudes and opinions concerning CAM, and subsequently participants were placed into 3 main groups. The first group is distinguished by a total rejection of CAM (n=11), while at the other end of the continuum, participants integrated biomedicine with CAM therapies (n=8). Those participants in between the two poles (rejection and integration) were characterized as „acceptance with reservations” and signify a heterogeneous category regarding composition and attitudes. COMMENTS - Most participants in our sample belonged to the „acceptance with reservations” category, that is, physicians who do not employ CAM in their praxis, albeit support their patients should they decide to utilize a CAM modality. Our inquiry aims to serve as a precursor to a quantitative study concerning CAM use.]

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[In our strong opinion in hospitals the efficient conversation among staff and patient and/or relatives is important. We try to draw attention to the psychosocial aspects of pediatric intensive care and the complex and special case of relative-staff communication via the introduction of a clinical case. Various medical experts were involved in the treatment of the infant and all participants witnessed the 4 months long life and the death of the newborn. The case of the intubed patient was painful and stressful for the medical staff. With our case-report, we try to present the spectrum, which forms during the treatment of a sickly born infant and the changes of the relationship of the medical staff and relatives as well as the engrossment of their interpersonal relationship along with the center of their communication problems and solution-finding. Our paper is centered around the psychosocial aspect of the clinical case and we would like to call the attention on how the medical experts communicated with the parents of the infant. ]

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