Internal medicine journal
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Internal medicine journal · Feb 2013
ReviewFamily refusals of registered consents: the disruption of organ donation by double-standard surrogate decision-making.
Some countries such as Australia, Spain, Norway, Italy and Canada allow next of kin to override the consent of registered organ donor candidates if they personally do not concur with the donation desire of their relative. This form of surrogate decision-making represents a double standard in terms of the principle of substituted judgment (the surrogate's duty). Further, double-standard surrogate decision-making in the setting of organ donation is a slippery slope to unethical surrogate decision-making while patients are alive. Concerns about family distress and donor candidate revocation of consent can still be managed without permitting double-standard surrogate decision-making.
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Internal medicine journal · Feb 2013
Unmet needs of people with end-stage chronic obstructive pulmonary disease: recommendations for change in Australia.
Chronic obstructive pulmonary disease (COPD) is an increasing cause of mortality. However, people with COPD are unlikely to receive care that meets the needs of themselves or their carers at the end of life. ⋯ A flexible model of care is needed that assists people with COPD to navigate the health system. This should be patient centred and coordinated across primary, acute and community sectors. Neither respiratory nor palliative care services alone can adequately support people with COPD. The integration of a multidisciplinary palliative approach within a chronic disease management strategy will be central for the best care for people living with advanced COPD.
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Internal medicine journal · Feb 2013
Hospitalisation of high-care residents of aged care facilities: are goals of care discussed?
Residents of residential aged care facilities (RACF) are commonly hospitalised towards the end of life. Determining the hospitalisation experiences, including the discussion of goals of treatment, is essential to best plan care including planning for end-of-life care for this population. ⋯ There were low rates of documentation of resuscitation status or family discussion for this highly vulnerable population. Neither hospitals nor community providers appear to take responsibility for future care planning. Acute hospitals could play a greater role in care planning because discussion around course of illness and goals of treatment may enhance patient management, satisfaction and reduce hospitalisations.