Comment: Outcomes and visions
Ilora Finlay
pp 120-120
Increasingly, those providing healthcare will be required to demonstrate positive outcomes and show that their care is underpinned by evidence of effectiveness. So the types of outcome that will be needed and the shape of services in the future are worth considering. Outcomes fall into four categories concerning the patient, their relatives, the health economics of the service, and the wider outcomes that relate to society as a whole.
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Critical appraisal of invasive therapies used to treat chronic pain and cancer pain
John Williams
pp 121-125
The new era of controlled trials is revealing less biased information about the role of invasive therapies in pain management. However, more controlled information is required to give clearer information to patients, medical colleagues (including the development of guidelines for clinical practice) and purchasers. Because of the heterogeneous nature of pain, there is a place for invasive therapies within a multidisciplinary environment and among carefully selected, targeted patients.
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The management of malignant wounds
Patricia Grocott
pp 126-129
Malignant wounds are caused by the infiltration of a local tumour or the metastatic spread of a primary tumour into the skin and its supporting blood and lymph vessels. Unless the growth of malignant cells is halted by single or combination treatments, extending fungation can cause massive damage at the wound site through proliferative growth, loss of vascularity and ulceration. The situation for the patient may be aggravated by tumour-related problems, for example lymphoedema as a consequence of impaired lymphatic drainage. Symptom control measures and wound dressings are the mainstay of the care of patients with malignant wounds.
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Euthanasia – a European debate
Helen Walsh
pp 130-132
Euthanasia is a complex subject, presenting both moral and ethical dilemmas. While every healthcare professional recognises the need for a ‘good death’, some argue that it is a fundamental human right. Within the UK the search for a good death has been through holistic care, appropriate symptom control and emotional support. Physicians within the Netherlands, however, have approached the challenge from a different perspective, responding to requests to end suffering by facilitating euthanasia – that is, by the direct killing of individuals at their own request to prevent further suffering.
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Why I oppose euthanasia in exceptional circumstances
René Schaerer
pp 133-133
We must recognise the serious nature of the report drafted by the Comité Consultative National d’Ethique pour les Sciences de la Vie et de la Santé (CCNE; National Consulting Ethics Committee for Life Sciences and Health) entitled, ‘Fin de vie, arrêt de vie, euthanasie’ (end of life, put an end to life, euthanasia). We must extol the firm stance taken against continuous therapy, and the reference in the report to the importance of patient autonomy, but, above all, the explicit reference to ‘the promotion of values, beyond which there would be no society’.
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Modernity, Britain and the culture of cremation
Lisa Kazmier
pp 134-137
Why on earth would anyone study cremation? To many people, it suggests the mere study of ‘dead people’ yet in examining developments up to the past decade, some of my subjects – and the cultural values they embrace – are very much alive. It takes a while for this irony to register; although sociologists, anthropologists and historians have long gained insight into a society through understanding its death rituals.
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When the family demands the discontinuation of morphine
Daniel Azoulay, Susan Brajtman, Malka Yehezkel, Ruth Shahal-Gassner and Aaron Cohen
pp 138-140
The problems encountered by the palliative care team when a patient’s family demands the discontinuation or reduction in dosage of an analgesic or sedative are complex and varied. Comprehensive dialogue and an understanding of the reasons behind the family’s request are paramount to achieve consensus and a workable compromise. Family reasons are extremely varied, personal and, at times, surprising and inconsistent. The most common impetus is based on the wish not to lose contact with the patient whose state of consciousness is steadily deteriorating.
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Bereaved children’s support groups: where are we now?
Mary Blanche and Sue Smith
pp 142-144
The provision of support for bereaved children has aroused much debate in recent months. Services for children have proliferated in the last few years and recent publicity given to an article by Harrington and Harrison highlighted the conclusion that most bereaved children do not need support outside their own families. However, the Harvard study has shown that approximately one-third of bereaved children do experience significant problems and are seen to be at significant risk two years after the death of a parent.
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Creativity and coming of age
Elizabeth Hall, Mandy Pratt and Lucinda Jarrett
pp 146-150
In the transition to adulthood we draw on a wide range of social influences, in particular adult role models and peers encountered directly or through the media. Our peers also provide support and affirmation that we are ‘okay’ as we explore the world with increasing independence and try to decide what really matters to each of us – in short, who we are. This is an account of one young person (Sarah) growing up in extraordinary circumstances, without the usual role models, without regular contact with a long-established peer group, without even the certainty that she would grow up.
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