Comment: It is our responsibility to promote care, not killing
Julia Riley, Rob George and Illora Finlay
pp 109-109
Those of us who work in palliative care units, looking after many terminally ill patients, aim to mitigate their suffering and help them to live with dignity until they die. However, a vocal media campaign has been promoting assisted suicide as the only sensible way to deal with the uncertainty of dying from terminal illness, the fear this brings and the suffering it engenders. ‘Dignity in Dying’, the new name of the Voluntary Euthanasia Society, reinforces this; and Ludwig Minelli, founder of Dignitas, a ‘centre for assisted dying’ in Switzerland, claims that, to die with dignity, we should be able to determine our ‘date with death’.
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Opioid use in the last days of life: what is good practice?
M Ruth Philp, Marlise Poolman, Nigel P Martin and Matthew K Makin
pp 110-115
Concerns have been raised in the media that doctors may routinely increase the dose of strong opioids, such as morphine and diamorphine, given to terminally ill patients with the intention of hastening their death. Indeed, speculation that clinicians are escalating doses to the point where patients become sedated and consequently die has led some to suggest that the medical profession covertly carries out euthanasia. These anxieties were brought more sharply into focus as a consequence of the murders by the GP Harold Shipman. There is also a belief, by some, that a crescendo of pain in the last days of life leads to an inevitable exponential increase in the dose of analgesia.
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Adapting the Liverpool Care Pathway for intensive care units
Laura Chapman
pp 116-118
Most large hospitals in the UK have a general intensive care unit (ICU), which accepts patients from all departments and with a variety of conditions (often requiring invasive respiratory support). Each ICU has its own admission guidelines.
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Case study masterclass 44: A recurrent case of pseudomembranous candidosis
Andrew N Davies
pp 120-121
Mary, a 68-year-old woman with advanced metastatic carcinoma of the thyroid, has been admitted to the palliative care unit for symptom control. On admission she complains, among other things, of a ‘dry mouth’, with associated oral discomfort. Examination of the oral cavity reveals clinical features of salivary gland hypofunction (that is, dryness of the mucous membranes and no pool of saliva in the floor of the mouth) and of pseudomembranous candidosis (that is, confluent lesions on the dorsal surface of the tongue and discrete lesions on the remaining oral mucosa) (see Figure 1, below). In addition, Mary has poor oral hygiene with overwhelming oral malodour (halitosis).
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Case study masterclass 43 answers: Fulfilling a patient’s wish to go home from intensive care
Lynda Tellett and Carol Davis
pp 122-122
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Summary Care Record – the Bury experience
Caroline Tait, Gillian Braunold, Rob Jeeves, Lynn Hopwood and Michael Thick
pp 124-126
End-of-life care has been placed high on both the political and clinical agendas, with the publication of the Department of Health’s End of Life Strategy and Lord Darzi’s Next Stage Review. In November 2008, the National Audit Office published a report on end-of-life care in England. It identified severe shortcomings in its provision and delivery, including the fact that the wishes of people approaching the end of their life were not always conveyed to those who needed to know. The report recommended that ‘such data should ideally be captured in the Summary
Care Record’. So what is the Summary Care Record, and how can it be used to improve the communication of end-of-life wishes?
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Recording lives: the benefits of an oral history service
Michelle Winslow, Karen Hitchlock and Bill Noble
pp 128-130
At the Sheffield Macmillan Unit for Palliative Care, an ‘oral history service’ is enabling patients to produce audio recordings of their life histories. The service is supported by charitable funds and run by the Academic Unit of Supportive Care, University of Sheffield.
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Reform and modernisation: developing a new service model for palliative care
Sonja J McIlfatrick, Donna Fitzsimmons, Gail Johnston, Roy McConkey, Margaret Cupples, Owen Barr and Felicity Hasson
pp 131-135
Palliative and end-of-life care is facing a period of unprecedented change, which is influenced by changing patterns of care, new policy frameworks and increased knowledge. Familiarity with death within society as a whole has decreased: generally, we do not discuss death or dying, and it can be argued that this has contributed to its low profile in health- and social care. It has been well documented that there is a major mismatch between people’s expressed preferences for where they should die and their actual place of death. It is also acknowledged that reform and modernisation of palliative care services are required to meet an increasing demand resulting from changes in demography
and the prevalence of chronic illness.
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Hospice and palliative medicine in the USA: the road to recognition
Dale Lupu, Dorothy N Moga, Russell Portenoy and Steven Radwany
pp 136-141
In 2006, the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME) approved the creation of a new medical subspecialty in hospice and palliative medicine. Within the framework of organised medicine in the USA, recognition by the ABMS and the ACGME was a critical step in the evolution of this discipline. The context and events that culminated in the formal acknowledgment of the new subspecialty have implications for clinical care and education in this field, and are described here.
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Where do cancer patients in Taiwan tend to die?
Ming-Hwai Lin, Heng-Liang Yeh, Szu-Ying Chu, Tzeng-Ji Chen and Shinn-Jang Hwang
pp 143-147
Although many patients with cancer would prefer to die at home, worldwide, most die in hospitals. We carried out a population-based study to look at the trends in the place of death in Taiwan between 1981 and 2004 and explore the factors associated with death at home of adult patients suffering from cancer. We used data from the death certificates of all adults who died of cancer in Taiwan during the period. We used logistic regression analysis to identify the odds of dying at home over time and the factors that might be associated with death at home.
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European insight: NPTN: palliative care comes under the spotlight in the Netherlands
Arianne Brinkman and Jaap Gootjes
pp 151-153
The development of palliative care in the Netherlands has boomed in the past 20 years, with the number of hospice facilities increasing from 38 in 1999 to 241 in 2008. The Dutch government has encouraged it through various programmes, and the Netherlands Palliative Care Network for Terminally Ill Patients (NPTN) has played an important role. In 2003, the 8th Congress of the European Association for Palliative Care (EAPC) took place in The Hague, further stimulating palliative care in this country.
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