Comment: Spiritual care on the rocks
Robert Becker
pp 136-136
At the conclusion of a presentation on the nature of spirituality during the recent EAPC Congress, a member of the audience, Professor David Clark, stood up and chose to provide what he called ‘an alternative perspective’. He proposed that the current movement towards understanding and expressing spirituality as a broad human need and distinct from religion is simply a way for hospice and hospital chaplains to broaden their power base and secure their jobs in an increasingly secular, non-believing society – at least within the UK.
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Malignant bowel obstruction
Fiona Rawlinson
pp 137-140
Malignant bowel obstruction presents distressing symptoms, for both the patient and family. It occurs when the bowel is either occluded by tumour, or peristalsis is ineffective. Although there has been an increased acceptance of a non-surgical approach to the palliation of the symptoms in patients with advanced disease, new techniques continue to be explored, and a holistic approach to care remains mandatory.
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Modified-release opioids
Mellar Davis and Andrew Wilcock
pp 142-146
Modified-release (MR) preparations of morphine, hydromorphone and oxycodone have been available for nearly 20 years. They have been designed to provide consistent analgesia over a period of 12–24 hours, reducing the frequency of administration to once or twice a day. Once stable pain relief has been obtained with normal-release (NR) preparations of morphine, hydromorphone or oxycodone, patients should generally be converted to MR preparations. Advantages include uninterrupted sleep, increased convenience and compliance, and a reduced risk of medication errors. Use of MR preparations to titrate the dose initially requires caution, particularly in the elderly and in cases of renal or hepatic failure.
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A focus on hereditary diseases
Donatien Mallet and Hacène Chekroud
pp 147-149
The question of the status of hereditary diseases in palliative care predates recent genetic discoveries. When trying to make sense of the ordeal that they are experiencing, patients question where the disease has come from and the potentially hereditary nature of their illness. Until the 1990s, biomedical technology failed to give a cast-iron answer to this question. Hereditary risk factors had been confirmed, notably for breast cancer and Huntington’s chorea, but genetic carriers had not been discovered.
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Can medical paternalism ever be justified?
Suzanne Kite
pp 151-154
Paternalism was the prevailing model for the doctor–patient relationship in Western medicine until relatively recently. The information revolution and an increasing emphasis on respect for individual autonomy have permeated healthcare, and transformed the relationships between patients and their healthcare teams. However, we are still faced with caring for patients who are very sick and whose autonomy is challenged. Paternalism is one possible response to this situation, but many, if not most, of us would dislike being labelled a ‘paternalist’ because of its negative connotations of denying patients their legitimate rights and wishes.
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The myth of mercy killing
Liv Wergeland Sørbye
pp 156-159
The level of competence in palliative medicine has never been better than today, yet the demand for voluntary active euthanasia is ever increasing. The modern culture of consumerism values functional capacity and productivity. In this climate acute medicine and patients who can be cured take priority over the chronically ill. However, conditions for the incurably ill must never be so miserable that death becomes the best solution. It is a myth that mercy killing maintains the patient’s autonomy and integrity. Dying with integrity is being surrounded by love and optimal care according to available resources. The myth of mercy
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Between the living and the dead
Hans Hadders
pp 160-162
For more than three decades we have seen a steady growth of a revivalist discourse advocating an awareness of death. This revivalism is paralleled with a growing general multifaceted interest in death and dying. Central to the rhetoric of the revivalist discourse is the notion that death is denied or a taboo topic. Seale claims, ‘To an extent, this is supported in the academic literature, being related to more generalised perceptions of the loss of a traditional community life accompanying modernisation. Classically, this has been expressed by Gorer in relation to mourning rituals, which he claims have atrophied in modern conditions’.
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Providing scope for creative growth in palliative care
Julia Obrian
pp 163-165
Establishing scope for growth through the therapeutic arts in palliative care demands a reappraisal of traditional therapeutic methods. Whether in group work or individual sessions, a responsive therapist will have in mind specific aspects of practice, which are characteristically distinct to palliative care. For the purposes of this article, the issues to follow will mostly be concerned with group work, but some of the principles explored are also applicable to individual work.
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The changing face of the day hospice
Judy Holmes
pp 166-169
Most day hospices operate by providing physical, social and emotional support for patients, plus a variety of other services, which may include medical intervention, symptom control and creative or artistic therapies.1 Day hospices do not appear to follow a specifically medical or social model but fall somewhere between the two. The general view among day hospice staff seems to be that it is ‘only a matter of time’ before they begin to carry out more medical procedures, the most likely of which will be the administration of bisphosphonate infusions. As palliative care develops
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