Articles: palliative-care.
-
Twenty-seven patients with pain from non-curable cancer, who did not respond to systemic pain treatment with opioids and coanalgesics without the occurrence of unacceptable side effects, were treated with intrathecal infusions. Two patients were treated satisfactorily with morphine alone, while the remainder were given a mixture of morphine and bupivacaine. Complete or good pain relief was reported by 23 patients and some relief by three patients. ⋯ No serious complications were recorded. The treatment of severe cancer pain by intrathecal infusion of morphine and bupivacaine seems to be a promising method. As the adjustment of doses takes some days, and as the main complication, post-spinal headache, occurs early in the course, the method is most suitable for use in patients expected to survive for at least a couple of weeks.
-
Support Care Cancer · Nov 1996
Pain and symptom control for cancer patients at the University Hospital in Essen: integration of specialists' knowledge into routine work.
At the University Hospital of Essen, supportive care for patients with cancer and other painful diseases is carried out by an interdisciplinary ambulant pain clinic supported by a pain conference with delegates from all departments involved in the care of cancer patients as permanent members. More than 600 in- and outpatients per year are treated by this institution. This model tends to integrate supportive care into the overall therapeutic concept and routine work and to improve education in this field by bedside teaching and training of local specialists in every department. ⋯ Scientific research in the field of palliative care, including supportive care, is a further concern of the pain clinic. Evaluation of the model shows that the concept has been realized within a decentralized and interdisciplinary setting; it must, of course, be borne in mind that the staff of the pain control clinic are deeply committed to their work. In conclusion, the way supportive care is realized in Essen can be recommended for large hospitals, and especially for medical schools.
-
The problems related to requests for euthanasia by terminal patients; the variations in attitude of palliative care physicians and the possibility that availability of the best palliative care might obviate the problem by eliminating requests for euthanasia, are under discussion. ⋯ The attitudes of physicians practising palliative care in Italy are not different from those reported by previous studies which investigated the attitude of other health professionals. There was no agreement about whether the best palliative care might reduce requests for euthanasia by terminal patients.
-
J Pain Symptom Manage · Oct 1996
ReviewThe ethics of death-hastening or death-causing palliative analgesic administration to the terminally ill.
Double-effect reasoning is a nonconsequentialist analysis of a hard ethical case. In a hard ethical case, one can achieve some good end only if one also causes harm. Sometimes palliative analgesic administration to a terminally ill patient is a hard ethical case, for by it one relieves pain or distress while unavoidably hastening or causing the patient's death. Is it ethically in the clear to administer an analgesic to relieve pain or distress knowing that one will hasten or cause the patient's death? Using double-effect reasoning, the author argues that death-hastening or death-causing palliative analgesic administration to a terminally ill patient is sometimes ethically in the clear and, at times, even obligatory.