Comment: A question of ethics
Juan M Núñez Olarte
pp 135-135
The recent gathering of palliative care professionals at the EAPC congress in The Hague provided an excellent venue for cross-fertilisation of ideas. Arguably, an area in the field of palliative care that needs this type of exchange is that of ethics. The congress certainly did not lack opportunities to address ethical issues. Two of the nine plenary lectures were devoted to ethics. Cultural dependency of the ethics of palliative care and legalisation of euthanasia and physician-assisted suicide (PAS) were the topics covered.
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Treatment of haemoptysis in palliative care patients
Dominique Anwar, Nicolas Schaad and Claudia Mazzocato
pp 137-139
Haemoptysis, whether related or not to a malignant condition, is a frequent problem in the palliative care setting. It is frightening for the patient and their family, as well as for the healthcare professional, and is a potentially lethal condition.
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Malignant epidural spinal cord compression
Paul Shaw and Annabella Marks
pp 141-144
Byrne describes malignant spinal cord compression (MSCC) as one of the most common neurological complications in cancer patients, occurring in about 5% and often resulting in major disability. It can occur at extradural (epidural), intradural or intramedullary sites. In a series of 155 cancer patients with suspected spinal canal disease undergoing MRI, malignant disease was found to affect the spinal cord or cauda equina in 65% of patients.
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Case study masterclass 10: Presentation of lung cancer and diabetes insipidus
Carol Davis and David Butler
pp 146-147
Mr Fergusson, a single, 68-year-old retired electrician and lifelong smoker, was diagnosed last year with squamous cell carcinoma of the lung. He had been referred urgently by his GP to the ear, nose and throat (ENT) department with a two month history of intermittent cough, productive of bloodstained tissue. He was otherwise well but a three-year history of increasing wheeziness was noted.
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Case study masterclass 9 answers: Rapidly progressing prostatic cancer
Carol Davis and David Butler
pp 147-147
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Rehabilitation in malignant spinal cord compression
Gail Eva and Sharon Lord
pp 148-150
Malignant spinal cord compression (MSCC) occurs in up to 5% of all patients with systemic cancer. The need for swift diagnosis and treatment is well documented, and is addressed in a separate article. What is less well described is the management, and specifically the rehabilitation, of people for whom the compression has resulted in neurological damage to the spinal cord. These individuals have many problems: loss of mobility, incontinence, sexual dysfunction, and the social and psychological sequelae of a sudden loss of independence.
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End-of-life care for older people
Ian Philp
pp 151-153
The death of the resident was not something that was to be discussed in the home. Screens were erected leading from her room to the lift, so that other residents would not be disturbed by seeing her being removed by the undertaker. Nevertheless, most were able to catch a glimpse of the plastic coffin being lifted into the hearse and, although not discussed, the event would dominate their thoughts and feelings for some time. The worst thing was that the same plastic coffin was used each time there was a death in the home.
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Training of care home staff
Jeanne Katz
pp 154-156
Increasing numbers of older people in Western societies end their lives in care homes, which, in the UK, include residential care homes, dual registered homes and nursing homes. Around 83% of deaths occur in old age, and a substantial number of these older people die in care home settings (about 18%). Traditionally, residential homes provide a safe environment for the relatively well older person who resides there for some years; nursing homes cater for the older, chronically ill, frailer and more dependent people whose stay in these settings is considerably shorter than in residential care.
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Palliative care and the principles of biomedical ethics
José António Saraiva Ferraz Gonçalves
pp 158-159
Medicine underwent huge developments in the 20th century. Until then, doctors were not able to do very much except relieve a few symptoms. Then, little by little, it has become possible to alter the natural course of many diseases and even cure some of them.
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What is all this pain good for?
Agnès Suc, Michel Vignes, Anne Isabelle Bertozzi-Salamon, Hervé Rubie, Alain Robert and Jean-Philippe Raynaud
pp 160-163
It goes without saying that paediatrics and psychiatry go hand in hand. As well as dealing with the fear aspect, psychiatry can complement the clinical work carried out in a children’s hospital, such as the one in Toulouse. The sad fact, however, is that young patients and their families often miss the opportunity for psychotherapy during the terminal phase.
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Tuberculosis, poverty and the first ‘hospices’ in Ireland
Clare Humphreys
pp 164-167
During the late 19th century tuberculosis was the leading cause of death in Britain and Ireland. However, unlike in England, Scotland and Wales, where mortality rates were in decline, the death rate in Ireland continued to increase throughout the 19th and into the early years of the 20th century. It peaked in 1904, when tuberculosis accounted for almost 16% of all deaths in Ireland.
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A room for dying in: patient’s need or nurse’s fantasy?
André Vagnair and Roland Forster
pp 168-169
Following a training course on management practices, we became aware of the possible impact of decisions, which may appear quite innocuous, on our patients. We, therefore, decided to investigate the impact that moving patients in the terminal phase may have on their quality of life.
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