Search Results for: end of life
General Anaesthesia in End of Life Care – GAEL.
by Dominic Wilkinson @Neonatalethics
Our paper General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery has been published today in Anaesthesia. It is part of a series of work led by researcher Antony Takla, together with Julian Savulescu and Dominic Wilkinson. The recent paper is a collaboration with Professor Jaideep Pandit, Professor of Anaesthesia at Oxford.
Press Release: Majority of UK public want choice at the end of life – survey
Most people in the UK would like the option of being heavily sedated, having a general anaesthestic or to having euthanasia, if they were dying, according to Oxford research published today in the medical journal PLOS One.
Professor Dominic Wilkinson, Professor Julian Savulescu and colleagues from the Oxford Uehiro Centre for Practical Ethics, surveyed more than 500 adults in August 2020 on their views about the care of a patient who had one week to live.
The study found a high level of support for access to deep sedation in dying patients.
Some 88% said they would like the option of a general anaesthetic if they were dying. Meanwhile, 79% of those surveyed said they would like to have the option of euthanasia.
But just 64% said they would personally choose anaesthetic at the end of life and nearly half said they would not choose euthanasia for themselves or a family member.
The report maintains, ‘This study indicates that a substantial proportion of the general community support a range of options at the end of life, including some that are not currently offered in the UK.’
According to Professor Wilkinson, ‘Previous surveys have shown that a large proportion of the UK public wish to have the option of euthanasia. This study shows an even larger number wish to have the choice of being heavily sedated or even receiving a general anaesthetic if they were dying.’
He continues, ‘Currently, in the UK it is legal for doctors to provide pain relief to dying patients, and to use sedatives if that is not enough to keep a patient comfortable. Heavy sedation is used as an option of last resort. General anaesthesia is not currently considered. But members of the general public value the option of deep sleep and complete relief from pain if they were dying. They believe that patients should be given this choice.’
Meanwhile, Professor Savulescu adds, ‘Patients have a right to be unconscious if they are dying. This survey shows that the general public want to have greater choice at the end of life.’
ENDS
Notes for Editors
For more information, please contact news.office@admin.ox.ac.uk
1. The survey is based on two anonymous online surveys of members of the UK public, sampled to be representative. They were given a scenario of a hypothetical terminally ill patient with one week to live and asked about the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia.
2. Across both surveys, a majority had undertaken higher education, with seven in 10 having A levels or higher qualifications. Meanwhile, just 2.4% overall had no qualifications.
3. Just over half of all respondents said they were religious with 13.8% describing themselves as very religious.
European Guidelines: How much cinnamon can go in our buns, and what kind of dignity do we want at the end of life?
Over on the Ethox blog Angeliki Kerasidou and Ruth Horn discuss the European Union and the need for cultural understanding between member states, with a focus on the concept of dignity at the end of life.
The results of the recent European elections revealed the disconnection between member states and the European Union. Populist anti-European parties won more seats than ever before challenging the dream for a united continent.[1] One of the main criticisms expressed by anti-European parties was that Brussels imposes a plethora of regulations and directives, from trade regulations and agricultural subsidies to the “amount of cinnamon in buns”, challenging individual member-states’ traditions and cultural particularities.[2]
Perhaps one way of interpreting 2014 European elections results is that achieving harmonization of policies is very difficult in a continent comprised of countries with different cultures and histories. And, yet, if the European Union is to continue and prosper, issuing policies and guidelines that could be accepted by all member-states is paramount.
See the Ethox blog to read the rest of Angeliki and Ruth’s post.
Watch your words! The challenges of law around the end of life
by Dominic Wilkinson
Here in South Australia last week, a bill has been proposed to clarify the legal status of advance directives. One very small part of that bill involves a modification to an older palliative care act. The modification corrects an ambiguity in wording in the earlier act. The ambiguity is subtle. However, that choice of words has had major consequences for seriously ill children and adults in South Australia and for health practitioners. It is a salutary reminder of how hard it is to enact good laws in the area of end of life, and how easily such laws can make things worse rather than better.
Tattoos and taboos: making end of life preferences known when it matters
A 79 year old euthanasia campaigner in New Zealand has attracted local and international publicity after having the words ‘Do Not Resuscitate’ tattooed across her chest. Although this seems unlikely to be widely emulated her action highlights the problem that at the time when it might be most important to make one’s views known, patients are often unconscious or incompetent.
Ending life and end-of-life care
Eve Richardson, chief executive of the National Council for Palliative Care and the Dying Matters coalition, argues that the government needs radically to improve end-of-life care in the UK, and makes several excellent suggestions about how that might be done.
I agree wholeheartedly, and would like to add a suggestion of my own: that end-of-life or terminal care should be a medical specialization not restricted to hospice care. Hospice care involves merely the palliation of patients’ symptoms (where such palliation is possible – sometimes, as in cases of advanced cancer, for example, pain cannot be controlled, and patients are left to die in agony). Such care should include voluntary euthanasia as a possible intervention. What might we call such a specialization? I suggest telostrics (telos being the ancient Greek word for end).
Of course, I am assuming that such euthanasia would be legal. But as it certainly should be, and quite probably soon will be, my suggestion here is not out of place.
It might be thought preferable that a loved one – a friend or relative – administer the fatal dose. That might indeed be best, but there may well be cases in which there is no suitable person available, or in which the patient would be concerned about the potentially traumatic effect it might have on that loved one.
What about an ‘ordinary’ medical practitioner? Why do we need a specialism that includes euthanasia? Again, this may work in some cases. But there is still a danger of trauma, and choosing what’s best for any particular patient may itself be difficult. Further, the issues surrounding end-of-life decisions, both for patients and their relatives, are complicated, and experience in them will often be beneficial for all concerned.
But aren’t doctors trained to sustain life? And won’t they be naturally traumatized by their killing others, just as most of us would be? Not all doctors think this way. Some of them see their role as making the lives of their patients as good as possible, and this may involve bringing that life to a less agonizing conclusion. Such doctors might, if my proposal were adopted, choose to become telostricians.
Should doctors come clean? Religion makes a difference to end-of-life decisions
In a paper released today in the Journal of Medical Ethics, a large survey of UK doctors found that doctors’ religion influenced their views and practice of end-of-life care. Why does this matter? A number of headlines highlighted that atheist or agnostic doctors were more likely to report having participated in “ethically contentious end-of life actions”: ie taking part in terminal sedation or in actions that they expected or partly intended would hasten the patient’s death. But other headlines emphasised the obvious flip-side: doctors who identified themselves as ‘very religious’ or ‘extremely religious’ were about 35% less likely than non-religious doctors to report having taken this sort of step.
Cross Post: Why Government Budgets are Exercises in Distributing Life and Death as Much as Fiscal Calculations
Written by Hazem Zohny, University of Oxford
Sacrificial dilemmas are popular among philosophers. Should you divert a train from five people strapped to the tracks to a side-track with only one person strapped to it? What if that one person were a renowned cancer researcher? What if there were only a 70% chance the five people would die?
These questions sound like they have nothing to do with a government budget. These annual events are, after all, conveyed as an endeavour in accounting. They are a chance to show anticipated tax revenues and propose public spending. We are told the name of the game is “fiscal responsibility” and the goal is stimulating “economic growth”. Never do we talk of budgets in terms of sacrificing some lives to save others.
In reality, though, government budgets are a lot like those trains, in philosophical terms. Whether explicitly intended or not, some of us take those trains to better or similar destinations, and some of us will be left strapped to the tracks. That is because the real business of budgets is in distributing death and life. They are exercises in allocating misery and happiness. Continue reading
Protecting Children or Policing Gender?
Laws on genital mutilation, gender affirmation and cosmetic genital surgery are at odds. The key criteria should be medical necessity and consent.
By Brian D. Earp (@briandavidearp)
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In Ohio, USA, lawmakers are currently considering the Save Adolescents from Experimentation (SAFE) Act that would ban hormones or surgeries for minors who identify as transgender or non-binary. In April this year, Alabama passed similar legislation.
Alleging anti-trans prejudice, opponents of such legislation say these bans will stop trans youth from accessing necessary healthcare, citing guidance from the American Psychiatric Association, the American Medical Association and the American Academy of Pediatrics.
Providers of gender-affirming services point out that puberty-suppressing medications and hormone therapies are considered standard-of-care for trans adolescents who qualify. Neither is administered before puberty, with younger children receiving psychosocial support only. Meanwhile genital surgeries for gender affirmation are rarely performed before age 18.
Nevertheless, proponents of the new laws say they are needed to protect vulnerable minors from understudied medical risks and potentially lifelong bodily harms. Proponents note that irreversible mastectomies are increasingly performed before the age of legal majority.
Republican legislators in several states argue that if a child’s breasts or genitalia are ‘healthy’, there is no medical or ethical justification to use hormones or surgeries to alter those parts of the body.
However, while trans adolescents struggle to access voluntary services and rarely undergo genital surgeries prior to adulthood, non-trans-identifying children in the United States and elsewhere are routinely subjected to medically unnecessary surgeries affecting their healthy sexual anatomy — without opposition from conservative lawmakers.
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