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"The book of life is the supreme book that we can neither close nor reopen at will". This quotation from Lamartine, the French poet, once a perfect illustration of neither the close of life in bygone societies, can no longer be said to apply. In fact, today, in one out of two cases in our modern societies, it is the medical team who closes this book without any intention of cutting life short. Generally, however, the physicians do not make this decision alone. While a competent patient increasingly participates in medical decisions, including when it's a matter of life or death, those nearest to him (usually the family but not always) endorse this responsibility once he becomes incapable of expressing his wishes. Many questions surround not only this concept of "nearest and dearest", or "loved ones", but aise their roles and legitimacy. Whether they act as the patients Iegal representative, authorised agent or trustee, or if they are stripped of all legal power, will the "doved one" be simply consulted by the caregivers on the presumed wishes of the patient regarding end-of-life choices ? Or must they guarantee him a genuine right of self-determination ? To this end, will they be granted a right of information only about the patients condition, or even access to his medical records ? Will their role be affected by the existence of living wills drawn up by the patient in question ? The outcome of debates between legal experts and physicians, philosophers and sociologists from seventeen countries, the chapters in this book analyse the current status and role of these relatives (and non- relatives) close to the patient at the end of life. Numerous European national laws are thus compared and are also benchmarked against other practices, in North and South America, in Africa and in some Asian countries. Beyond the legal, cultural and ethical differences that clearly separate these various traditions, a recurrent question arises: more than providing paternalistic protection, does the "loved one" not always have to ensure respect for what "their patient" would have wanted, thus guaranteeing up to the end of his lite a basic right, namely his decision-making autonomy ? If this book demonstrates the difficulty of such a task in different contexts, it also attempts to pave the way to a more humanistic approach across cultures to advocate respect for the patient at the very end of his lite.
...cts of family ... Adolescent, Autonomy and Medical Treatment Divergence and convergence across the globe De Réseau universitaire international de bioéthique, Workshop international Dirigé par Brigitte Feuillet-Liger, Ryuichi Ida, Thérèse Callus Bruylant Edition Lsb ... End-of-Life Care Family Meeting • LITFL • CCC Clinical ... ... . Dr.Bioethi The End-of-Life Care Family Meeting is a core component of ICU care; Evidence suggests that communication with families is often inadequate; The principles apply to end-of-life discussions in other settings (e.g. ED) as well END OF LIFE When a person with late-stage Alzheimer's — a degenerative brain disease — nears the end of life and is no longer able to make his or her own decisions, families must make choices on the person's behalf. Ideally, the person with dementia ... Families and End-of-Life Treatment Decisions - Ouvrage Larcier ... .g. ED) as well END OF LIFE When a person with late-stage Alzheimer's — a degenerative brain disease — nears the end of life and is no longer able to make his or her own decisions, families must make choices on the person's behalf. Ideally, the person with dementia has put in place advance directives that specify his or her wishes. Without such ... Patients need to understand—in more than a cognitive sense—that they are at the end of life, then they readily accede to the end-of-life decision-making model. But we know little of how that actually transpires—particularly how physicians, families, and patients construct a mutually agreed-on narrative—because of the limited bioethics research focus on choice. Family perspectives about end-of-life (EOL) care have become a priority in healthcare as our population continues to age. The Administration on Aging predicted that the present percentage of older Americans (those aged >=65 years) will grow from 12.8% of the population to 19.3% by 2030.1 According to Day,2 more elders are dying in long-term care, and in a given year, for every 100 elderly ... In several narratives reporting problems with symptom management and other end-of-life treatment, the care improved when hospice became involved. One respondent was pleased by an increase in attention in the care of her 86-year-old aunt with pancreatic cancer with hospice services: "They had counselors in talking with her everyday. … There was a tremendous amount of support available." Talking with Patients and Families About Treatment Withdrawal Ideally, family and patient should be involved in decision making long before implementation is necessary; this allows family members to hear 256 Family Dynamics in End-of-Life Decisions what the patient wishes and why [1,21,24,25]. Even when a living will exists, it is important to explore specific treatment preferences, e.g ... During Mrs. O'Riley's final hospitalization I reflected on the time she was my patient. Initially I was bothered that she had been intubated at all. I wished I had been able to establish code status with her prior to this final hospitalization, and wondered if she would have wanted a "do not intubate" order from the beginning. Colleagues reminded me that I had tried to discuss it, but she ... -term-care settings. By exploring family perspectives on the dying process, the intention of the researchers was to further expand the knowledge and standards of care regarding the end-of-life care. To pursue this goal, the researchers interviewed family members who had lost a loved one in a long-term-care facility during the prior 3 to 18 months. The research questions were as follows: (1 ... End-of-life care is that part of palliative care that focuses on patients who have life-threatening diseases and a life expectancy of 6 to 12 months [1, 2].It helps patients to die in peace, comfort, and dignity .Globally, the estimated number of people in need of end-of-life care is 20.4 million .By 2040, an estimated 75% to 88% of patients at the end-of-life stage could benefit from ... The U.S. Supreme Court says Americans should expect palliative care, which combines active and compassionate therapies to comfort and support people and their families nearing the end of life. Psychologists can make significant contributions to improve the quality of end-of-life care and decision-making. Families often avoid conversations about end-of-life care until an emergency forces them to start planning. "We end up trying to make these decisions under a greater degree of emotional strain or emotional distress," Duncan says. This high level of stress can create an environment that fosters conflict among family members. End-of-life decision making is one of the most difficult but crucial challenges faced by patients and their families. In most cases, resources or counselors providing guidance in these decisions are not available. This book is intended to prepare nurses, physicians, and other health care workers to fill this role, insofar as they are most frequently in contact with the patient and his/her ... Authors who study difficult and complex end-of-life decisions stress the need to distinguish personal perspectives on the transition, decision styles, and decision heuristics, and to educate those ... The goal of the study was to assess perceived level of satisfaction with end-of-life care, focusing on the last 48 hours of life. A previously validated instrument was used in a telephone survey with bereaved family members (n=90) of patients who died within an organization in British Columbia. Bereaved family members had many unmet needs for information about the patient's changing ... Families and end-of-life treatment decisions: an international study . B...