The debate over physician-assisted suicide: empirical data and convergent views.
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Consensus↗
Biomedical subjects
J A Billings
Publications and source records attributed to J A Billings.
Nurturing humanism through teaching palliative care.
After many years of neglect by the medical establishment, the discipline of palliative medicine is finally moving into academic health centers (AHCs). While hospice programs have cared for dying patients in the community for years with little input from mainstream medicine, palliative care is gaining a foothold in AHCs, challenging these centers to integrate the hospice approach with biomedicine. The discipline of palliative care promises to be a rich source of learning and growth for physicians-in-training. Teaching about palliative care affirms two essential but vulnerable dimensions of the practice of medicine--the importance of relationship-centered care and the value of doctoring as a source of meaning and growth for physicians. In addition to fostering fundamental humanistic learning, palliative medicine is an excellent vehicle for teaching basic but often neglected clinical competencies, including pain and symptom control, communication, and working as part of a health care team. Because palliative care settings offer extraordinary learning opportunities, the authors recommend that clinical experiences in palliative care be integrated into the core curricula of all medical schools as well as appropriate residency programs.
Academic Medical Centers↗
Palliative care in undergraduate medical education. Status report and future directions.
OBJECTIVE: To describe the status of palliative care education in the undergraduate medical curriculum and to offer recommendations for improvement. DATA SOURCES: Review of literature on palliative care and of recently submitted grants on medical education for end-of-life care. STUDY SELECTION: English-language reports of educational programs targeted toward medical students were examined, as well as surveys of medical schools. DATA EXTRACTION: Studies were reviewed by the authors to assess the quality of the educational program, evaluation methodology, and conclusions. From over 9000 citations on palliative care and related topics that were retrieved from MEDLINE searches from 1980 through 1995, and from reviewing 14 palliative care journals published from 1985 through 1996, 310 articles were identified that addressed medical education for end-of-life care, and 180 were carefully examined. DATA SYNTHESIS: While nearly all medical schools offer some formal teaching about end-of-life care, there is considerable evidence that current training is inadequate, most strikingly in the clinical years. Teaching about palliative care is received favorably by students, positively influences student attitudes, and enhances communication skills. However, curricular offerings are not well integrated; the major teaching format is the lecture; formal teaching is predominantly preclinical; clinical experiences are mostly elective; there is little attention to home care, hospice, and nursing home care; role models are few; and students are not encouraged to examine their personal reactions to these clinical experiences. CONCLUSIONS: The increasing attention to palliative care education has created major opportunities for improving education about care at the end of life. Educational programs should be rigorously evaluated to identify best educational practices.
Cultural Diversity↗
Opportunity to present our observations and opinions on slow euthanasia.
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Euthanasia↗
Slow euthanasia.
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Attitude of Health Personnel↗
Regulating physician-assisted death.
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Depression↗
Patient requests to hasten death. Evaluation and management in terminal care.
Terminally ill patients often hope that death will come quickly. They may broach this wish with their physicians, and even request assistance in hastening death. Thoughts about accelerating death usually do not reflect a sustained desire for suicide or euthanasia, but have other important meanings that require exploration. When patients ask for death to be hastened, the following areas should be explored: the adequacy of symptom control; difficulties in the patient's relationships with family, friends, and health workers; psychological disturbances, especially grief, depression, anxiety, organic mental disorders, and personality disorders; and the patient's personal orientation to the meaning of life and suffering. Appreciation of the clinical determinants and meanings of requests to hasten death can broaden therapeutic options. In all cases, patient requests for accelerated death require ongoing discussion and active efforts to palliate physical and psychological distress. In those infrequent instances when a patient with persistent, irremediable suffering seeks a prompt and comfortable death, the physician must confront the moral, legal, and professional ramifications of his or her response. Rarely, acceding to the patient's request for hastening death may be the least terrible therapeutic alternative.
Attitude to Death↗
Medical education for hospice care: a selected bibliography with brief annotations.
This is a briefly annotated bibliography of useful materials for the education of health professionals, principally physicians. It encompasses teaching goals, methods, and settings, as well as model courses, course evaluation, communication skills, general resources on death education, and miscellaneous background pieces.
Education, Medical↗
Why doesn't your hospice program have a strong medical director?
The question is not whether you need a medical director but what is his or her role. The agency should empower the director--an appropriately trained physician--to assure quality of care and take an active role in marketing and other administrative functions.
Hospices↗
Comfort measures for the terminally ill. Is dehydration painful?
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Dehydration↗
A seminar in 'Plain Doctoring'.
Plain Doctoring is an elective, preclinical seminar on the phenomenology of the patient and the physician. Home visits by students serve as the major text for examining the patient's experience of illness and treatment and for reflecting on the process of attending to patients. Readings in the humanities complement the house calls. The students, the patients, and the seminar instructors have all commented favorably on the seminar.
Curriculum↗
Tips, status and sacrifice: gift giving in the doctor-patient relationship.
This study examines the gifts physicians receive from their patients. Internists in a hospital-based group practice kept diaries of gifts received and were interviewed about their responses and the reasons which they ascribed to the patient's gift-giving. It describes how physicians avoid reciprocating, categorizes the nature of gifts and, for the special instance of manipulative gifts, how these may be defused. Patient gifts are found to be reciprocations for some action on the part of the physician, which the patient, in turn, perceives as a gift. Three categories of gifts, according to their nature and timing, are: (1) gifts as 'tips', given to promote personalized service, to assure the continued interest and the tolerance of the physician; (2) gifts to address the status imbalance in the doctor-patient relationship, either by imposing a non-professional identity on the physician or by redeeming status lost in the sick role; (3) gifts as a sacrifice to the physician who exercises his power on the patient's behalf.
Age Factors↗
Kinetic assay of human pepsin with albumin-bromphenol blue as substrate.
A novel substrate, albumin complexed with bromphenol blue, has been developed for the assay of human gastric juice pepsin by a kinetic method in the Cobas centrifugal analyzer. The action of pepsin on the complex degrades the albumin and releases the dye. The change in the color of the substrate is a zero-order reaction. Human and porcine pepsin have different Km's with the new substrate. This kinetic method has a throughput of 28 tests in approximately 10 min and good precision (CV = 2.0%). Other advantages are analysis in homogeneous solution (thereby eliminating the need to separate substrate and products), lack of interference from bilirubin or phenol red, and the expression of pepsin activity in IUB enzyme units.
Albumins↗
The effect of cimetidine on pepsin secretion in patients with Zollinger Ellison syndrome.
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Adult↗
Relation between postoperative antithrombin III concentrations and site of operation.
Antithrombin III concentrations were measured in 305 patients before and at intervals after operation for up to 12 days. The blood concentrations fell significantly after both major and minor surgery, but there was no relation between the expected degree of surgical trauma or the amount of blood transfused and the fall in concentration of antithrombin III. Some surgical procedures such as cholecystectomy, laparotomy, hernia repair, highly selective vagotomy, and transurethral resection of the prostate were associated with a greater depletion of antithrombin III than were other common operations and it is suggested that there are factors related to the actual site of the operation which affect the concentration of circulating antithrombin III in the postsurgical period.
Antithrombin III↗