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For instance, the Independent Commission on Assisted Dying recommends that doctors "be allowed to prescribe drugs to end the lives of terminally ill patients who have fewer than 12 months to live" (Beckford, n.p.) However, the commission according to Bedford further points out that such individuals must be "judged to have the mental capacity and clear desire to die." In such a case, physician-assisted suicide will be available to only a select few. ith the right mechanisms in place, fears over 'death on demand' or concerns regarding the 'commercialization of death' will be put to rest. In their own words, Kopelman and De Ville point out that "one very important factor affecting the potential for abuse of any practice is what safeguards are erected to guard against the abuses most feared and likely" (64). ith that in mind, the relevance of proper safeguards when it comes to physician-assisted suicide cannot…
Battin, Margaret P. Ending Life: Ethics and the Way We Die. New York: Oxford University Press, 2005. Print.
Beckford, Martin. "Allow Assisted Suicide for Those with Less Than a Year to Live." The Telegraph. N.p., 5 January 2012. Web. 6 August 2012.
Bryant, Clifton D. Handbook of Death and Dying. Volume 1. California: SAGE, 2003. Print.
Devettere, Raymond J. Practical Decision making in Health Care Ethics: Cases and Concepts. 3rd ed. Washington: Georgetown University Press, 2009.
population ages, it will become increasingly important to know how to care for the chronically ill and dying elderly patients. An article in American Family Physician details one of the problems that arises in such cases: denial. The article tells about an incident where a man who is in constant pain repeatedly goes to the doctor, but will not accept that his symptoms could be caused by cancer. When the doctor offers to make a referral to hospice for extra help, the patient adamantly refuses the care. At first the physician does not give up his potential persuasions, which include stressing the patient's personal responsibility concerning the need for loved ones to see him free of pain. Yet the same scenario continues until, unfortunately, the man dies.
The author of the article, Dr. Karen Ogle, explains that denial is a common coping mechanism in the terminally ill. People rely on…
Unforunately, notes Ogle, there will always be those idividuals who never want to accept the truth and remain in denial until they die, like this above-noted patient,. This is even when such people realize the negative effect this is having on their spouse, children and other family members and friends.
This is not wrong or bad. Everyone has his or her own way of "dying well." How a person is acting has a reason, even if it is unknown to the observer. However, in some instances, the most beneficial support the healthcare profession can offer is just to join with the patient and his or her family in the manner elected but not understood by outsiders. This often means to leave behind the usual "toolbox" of medical responses and instead rely on the basic goodness of humankind. As she concludes: "Caring for the dying is remarkably challenging work. It can also be remarkably rewarding. If we meet the deeper challenges requiring our presence as human beings, this work can be among the greatest privileges of being a physician."
Ogle, Karen. "Approaching a terminally ill patient in denial." American Family Physician, October 1999. [electronic version].
Pediatric Nurse Practitioner in the Care of Terminally Ill Children
Pediatric nurse practitioners provide a valuable contribution to the care of chronically and terminally ill children. This position is essentially a subtype of advanced practice nurse, whose function is to provide the best possible patient care for ill children. This position functions within a pediatric hospital setting, in which the goal is to provide cost-effective patient care that meets and exceeds the needs of patients and their families. Although the pediatric nurse practitioner may work with children that present with acute or chronic illnesses, there is a critical need for nursing practitioners that are motivated to work with terminally ill children. Terminally ill children and their families present unique needs and situations that require knowledge, expertise, and intervention skills beyond what conventional nurses can offer. This population requires specialized care that can be fulfilled by a trained pediatric nurse practitioner.…
Knight, J. (1990). The Betty Neuman Systems Model applied to practice: A client with multiple sclerosis. Journal of Advanced Nursing, 15, 447-55.
McAtee, P. & Silver, H. (1974). Nurse practitioners for children: Past and future. Pediatrics, 54(5), 578-82.
De Moutigny, F. (1995). Family nursing interventions during hospitalization. Canadian Nurse, 91(10), 38-42.
Teicher, S., Crawford, K., Williams, B., Nelson, B., Andrews, C. (2001). Emerging role of the pediatric nurse practitioner in acute care. Pediatric Nursing, 27(4), 387-91.
Nutrition: Ethical or Unethical?
Should nurses withhold or withdraw nutrition & Hydration from terminally ill patients? This is a question that boggles the mind. Some feel that withholding anything from any patient is unethical, while others feel it is acceptable because we must promote quality of life. Furthermore, who decides within this issue the outcome of the patient? Nurses? Nurses? The Court? Recently, we have decided on a combination of the two. However, in order to discover what is actually best for patients, it is important to exmaine this paper.
What care is 'futile'? Throughout the years, the question of whether or not to withhold certain treatments to terminally ill patients has been addressed. Do we continue to treat people who are still alive, even if we know that there is no hope? This is a question that has been asked over and over again by various parties. This notion…
Issue: July, 2000 Nursing Library.
Huffman, Grace. "Artificial Nutritional Support..." Internet. Available Online. http://www.findarticles.com/cf_0/m3231/7_30/63583997/p1/article.jhtml?term=withholding+care+to+terminally+ill+patients
Issue: July 1, 2001 American Family Physician.
It is related that "This patterns of delayed referral does more than deprive individuals of palliative care-it jeopardizes hospice programs themselves. To be financially viable, hospice programs, which receive per diem reimbursements, must be able to balance out the high initial costs of services to new patients with the lower costs of maintaining stabilized patients." (Open Society Institute - Project on Death in America, 2007) Finally, it is related that "high quality end-of-life care depends upon an integrated network of in-hospital, out-patient, home and nursing home services." (Open Society Institute - Project on Death in America, 2007) Issues requiring research which present barriers to the provision of comprehensive quality palliative care include the issues as follows: (1) How does the six-month eligibility requirement affect patient access to end-of-life care?; (2) What is the impact of delayed referrals on hospice services?; (3) Are there cost incentives within HMOs to rush patients…
Thomas, Keri Dr. (2003) Caring for the Dying at Home: Companions on the Journey. Chapter Five Excerpts. Online available at http://www.goldstandardsframework.nhs.uk/content/guides_and_presentations/Evidence_base.doc
Cramer, LD et al. (2003) Nurse's Attitudes and Practice Related to Hospice Care. J Nurs Scholarsh. 2003;35:249-255
Wright, K. (2002) Caring for the Terminally Ill: The District Nurse's Perspective. Br J. Nurs. 2002;11:1180-1185
Palliative Care (2007) Nursing Matters - Fact Sheet. Online available at http://www.icn.ch/matters_palliative.htm
business strategy class, group assigned a case study. It a 12-20-page paper, responsibility write 4 pages, part write. Here teacher instruction: "A case study assigned group. Additionally a rubric showing material case study included.
Recently, a young woman dying of brain cancer in Queens was forced to engage in a legal struggle with her own parents to 'win' the 'right to die. "Paralyzed from the waist down, the 28-year-old woman won court approval last week to be taken off life support, a move challenged by her devout Christian parents who claimed that would be tantamount to suicide and would be a sin that would send their daughter to hell. After winning the right to die, Grace changed her mind. Her lawyer, David Smith, said she made the decision out of love for her parents and to alleviate their suffering" (Scott 2012). This case illustrates how right-to-die cases can…
Fraser, Sharon I. & James W. Walters. Death - whose decision? Euthanasia and the terminally ill. Medical Ethics 26 (2000):121-125. [21 Oct 2012]
Quill, Timothy E. "Terri Schiavo -- a tragedy compounded." The New England Journal of Medicine, 352(2005):1630-1633. [21 Oct 2012] http://www.nejm.org/doi/full/10.1056/NEJMp058062
Scott, Marvin. "Saving grace." WPIX. 2012. [21 Oct 2012]
Euthanasia, Should Terminally Ill Patients Be Allowed to End Their Lives Via Assisted Suicide
TEMINALLY ILL PATIENTS BE ALLOWED TO END THEI LIVES VIA ASSISTED SUICIDE
Euthanasia, notably called assisted killing or mercy killing, is perhaps one of the medical prescriptions that have always raised varied and multifaceted arguments, most of which have never reached any solid conclusion. Clinicians are prone to take every necessary step necessary to keep the health of a patient at stable conditions. Nonetheless, there come a time when the patient knows, together with the clinician, that there is a lesser chance of survival. In such situations, health professionals are stuck between assisting the patient to die, notably by using an external means, or letting him or her to fight for life until death, something that might be painful, both to the clinicians, the patients, and even the loved ones. Assisting a patient to die, with…
Weber, W. (2000). Dutch Proposal for Children's Right To Euthanasia Withdrawn. Lancet, 356(9226), 322.
young, most of us do not think about making a conscious decision to die. e look forward to years of long and healthy life, and if death ever seems appealing it is as an antidote to depression. It does not often, if ever, occur to us that there will be a time when we look forward to the "good death" promised by euthanasia.
But it is inevitable that for many of us there will come a time in our lives when suicide may indeed seem appealing because we are fighting a losing battle against a certainly fatal disease that fills our remaining days with pain and despair. In such a position many of us may wish to have our doctors help us die by prescribing for us drugs that when we ourselves take them will prove to be fatal. Or we may wish that other people should have this option…
Callahan, Daniel, "Good Strategies and Bad: Opposing physician-assisted suicide," Commonweal, December 3, 1999, sec1. 7+.
Cassel, Christine K. "AMA Guidelines for Caring for Patients in the Last Phase of Life.," CQ Researcher 7 (1997): 774. ( http://www.ama-assn.org/sci-pubs/amnews/amn_97/edit0721.htm )
Humphrey, Derek. Euthanasia: Essays and Briefings on the Right to Die. Los Angeles: Hemlock Society, 1991. http://deathwithdignity.org/euth_us2htm .
Orric, Sarah. "House Judiciary Committee Rationale." Congressional Digest 77 (1998); 263-264.
Additionally, I believe:
Voluntary euthanasia devalues life, like the disabled, the mentally incompetent, the terminally ill. (Verhagen, Sauer and Callahan 6).
It is against the various religious beliefs, including the Islamic faith, Buddhism, and certain Christian creeds.
The attending doctor should have the final say over the treatment of the patient in keeping with the Hippocratic Oath .
Doctor- monitored palliative care can allow the affected patient to die in peace, in a natural course of death.
Counseling and support can ease fear of death and pain.
Voluntary euthanasia devalues life. A method for judging the morality of this act is the Principle of Double Effect. Arguments against this act include: the devaluation of life concern, going against various religious belief systems; palliative care options should be provided first; and counseling and support should be first choice options.
Sulmasey, D.P. And E.D. Pelligrino. "The Rule of Double Effect."…
Sulmasey, D.P. And E.D. Pelligrino. "The Rule of Double Effect." Archives of Internal Medicine (1999): 545-550.
Verhagen, a.A. Eduard, et al. "Are Their Babies Different from Ours?": Dutch Culture and the Groningen Protocol." Hastings Center Report 38.4 (2008): 4-7.
Life and Death: The Life Support Dilemma by Kenneth E. Schemmer M.D
Kenneth Schemmer in his thorough, thought provoking book brings to life the controversial subject of the life support issue. For years, many all over the country have pondered, "What if a person were in some kind of an accident and the physicians told them that they were not going to make it?" And all that he or she could do is just lie there in extreme pain waiting for their life to the end. Or even worse case scenario what if they happened to end up completely brain dead? These debated questions are taken on by Dr. Schemmer in making his point that life support decisions may not necessarily be the decision of the family, the doctor or the patient but by a higher being that gives life and takes life. Schemmer uses these controversial questions in his…
Court backs right to die | terminally ill have right to refuse medical life support. (1984, Dec 28). The San Diego Union, pp. A.1-1.
Ackerman, T. (2005, Mar 27). Life support battle shifts / A decade ago, patients families had to press for 'right to die. Houston Chronicle, pp. 1-B.1.
Allen, P. (2000, Oct 07). Right to die upheld despite new euro law, doctors can end life support rules judge. Daily Mail, pp. 33-33.
Dolan, M. (2001, Aug 10). Justices deal setback to right-to-die movement; health: State court bans removal of life support from conscious patients whose wishes are not clear. Los Angeles Times, pp. A.1-A.1.
Patients also say they want to awake and conscious when their pain is managed. The issue is that there are not many U.S. physicians and nurses who are certified to extend palliative care. There are only 33 physicians and only 41 nurses for every 10,000 patients (Peres).
The hospice movement has been changing the face of care for people at the end-of-life stage (Radulovic 2004). Hospices have been providing options and choices to these patients for the last three decades. The hospice movement began in the UK but spread to America in response to the need for more compassionate care for the dying and terminally ill. A hospice is not a place but a concept of palliative and support services for the terminally ill to be cared for primarily at home. A home can be the patient's residence or that of a loved one, a long-term care facility. It provides…
Bone, Roger C. Analysis of Indications for Intensive Care Unit Admissions. Chest:. American College of Chest Physicians, December 1993
Earl, C et al. "Rise in Aggressive Treatment." Trends in the Aggressiveness of Cancer Care Near the End of Life. Journal of Clinical Oncology:. Springhouse Corporation, 2007
Peres, Judith. U.S. End-of-Life Gets Passing Grade. Health Care Benchmarks and Quality Improvement: American Health Consultants, Inc., 2003
Radulovic, Jan.W. Trends in Hospice and Palliative Care in the United States and Kansas. Kansas Nurse: Kansas State Nurses Association, 2004
Euthanasia is a big health controversy that has been discussed for many decades. People hold differing beliefs and opinions in regards to euthanasia. The term euthanasia basically means the practice of willingly terminating a person's life in order to relieve the person of any suffering or pain. Taking of the person's life is usually at the express instructions of the person. There are two different kinds of euthanasia involuntary and voluntary euthanasia. According to Jochemsen and Keown (1999)
voluntary euthanasia involves the patient having requested that their life be taken in case they suffer from an incurable disease which is causing them too much suffering and pain. Involuntary euthanasia occurs when a doctor or physician makes the decision to terminate a patient's life because the patient cannot recover and keeping them on life support will not have any positive effect.
Euthanasia does contradict with the basic moral principle of…
Asch, D.A., & DeKay, M.L. (1997). Euthanasia among U.S. Critical Care Nurses: Practices, Attitudes, and Social and Professional Correlates. Medical Care, 35(9), 890-900. doi: 10.2307/3767454
Campbell, N. (1999). A Problem for the Idea of Voluntary Euthanasia. Journal of Medical Ethics, 25(3), 242-244. doi: 10.2307/27718299
Jochemsen, H., & Keown, J. (1999). Voluntary Euthanasia under Control? Further Empirical Evidence from the Netherlands. Journal of Medical Ethics, 25(1), 16-21. doi: 10.2307/27718228
Moulton, B.E., Hill, T.D., & Burdette, A. (2006). Religion and Trends in Euthanasia Attitudes among U.S. Adults, 1977-2004. Sociological Forum, 21(2), 249-272. doi: 10.2307/4540938
Taking one's life as a result of the fact that the respective person is expected to suffer inhumane pain for several years until his or her death cannot possibly be compared with murder or suicide. Morality should actually be combined with logics in understanding euthanasia and people need to be more sympathetic and less egocentric regarding individuals who prefer euthanasia as the "safe way out."
Allen, Jen & Chavez, Sonia & Desimone, Sara & Howard, Debbie & Johnson, Keadron & Lapierre, Lucinda & Montero, Darrel & Sanders, Jerry "Americans' Attitudes toward Euthanasia and Physician-Assisted Suicide, 1936-2002," Journal of Sociology & Social Welfare 33.2 (2006)
Dowbiggin, Ian a Merciful End: The Euthanasia Movement in Modern America (New York: Oxford University Press, 2003)
Gailey, Elizabeth Atwood Write to Death: News Framing of the Right to Die Conflict, from Quinlan's Coma to Kevorkian's Conviction (Westport, CT: Praeger, 2003)
Neuhaus, Richard John "The…
Allen, Jen & Chavez, Sonia & Desimone, Sara & Howard, Debbie & Johnson, Keadron & Lapierre, Lucinda & Montero, Darrel & Sanders, Jerry "Americans' Attitudes toward Euthanasia and Physician-Assisted Suicide, 1936-2002," Journal of Sociology & Social Welfare 33.2 (2006)
Dowbiggin, Ian a Merciful End: The Euthanasia Movement in Modern America (New York: Oxford University Press, 2003)
Gailey, Elizabeth Atwood Write to Death: News Framing of the Right to Die Conflict, from Quinlan's Coma to Kevorkian's Conviction (Westport, CT: Praeger, 2003)
Neuhaus, Richard John "The Always Lively Newsletter Catholic Eye Reflects on Why it Is That Older People Who Are Strongly Pro-Life Are Tempted to Succumb to a Measure of Ambivalence When the Subject Turns to Euthanasia," First Things: A Monthly Journal of Religion and Public Life May 2007: 65
While the medical field agrees that prolonged suffering is not a desired product of medical care it has not yet reached the point of accepting that it is actually torture.
When we are at war we have soldiers how are standing trial for the torture and inhumane treatment of prisoners of war, however, we are not allowed to prevent that same level of torture from being thrust upon our loved ones who are ill / this makes no sense. Making someone endure the fevers, the pain, and the physical maladies that come with many of the life ending diseases today is actually a form of torture. It makes a person suffer against their will and at the hands of someone else, in this case the medical community.
More recently there have been strong arguments in courtrooms regarding Euthanasia and the right to choose to die now rather than later after…
____(2006) Jury to Rule Whether Woman Had Right to Die
South Florida Sun-Sentinel
Doerr, Ed. (1997)The Right to Die. The Humanist
According to eno congress had not intention "to displace the states as the primary regulators of the medical profession and as not to override a states' determination of that which "constitutes legitimate medical practice in the absence of a prohibitive federal law.
In November of 2001 Attorney-General Ashcroft "issued an interpretive rule, known as the Ashcroft Directive that reversed his predecessor's legal analysis of the conflict between the DWDA and the CSA." (Pew Forum on eligion & Public Life, 2005) The Ashcroft Directive "asserts the authority of the attorney general to identify and establish a uniform national definition of 'legitimate medical purpose' as used in the CSA and its implementing regulations" (Pew Forum on eligion & Public Life, 2005)
That very same year the Supreme Court made a decision in the case United States v. Oakland Cannabis Buyers' Coop. (2001) which gives weight to the Directive. Furthermore, the Office of…
Stevens, Kenneth R., Jr. M.D. (2005) Community Conversation Panel: Assisted Suicide v. Death with Dignity. University of Oregon Online available at http:.//wwww.pccef.org/articles/art42UofO.htm.
Supreme Court Considers Challenge to Oregon's Death with Dignity Act: Gonzales v. Oregon and the Right to Die (2005) The Pew Forum on Religion & Public Life. September 2005.
Hamilton, N. Gregory et al. (2005) Competing Paradigms of Response to Assisted Suicide Requests in Oregon. Physicians for Compassionate Care Educational Foundation Online available at http://www.pccef.org/articles/art39.htm .
New Court Mulling Assisted-Suicide Law (2005) Catholic Sentinel 6 October 2005 Online available at http://www.sentinel.org/articles/2005-40/14227.html .
eport on Conditions at Brighton and Sussex University Hospitals NHS Trust
The following report is based on extensive observation of the conditions for patients living at the Brighton and Sussex University Hospitals NHS Trust. While some patients received moderate care, overall, the quality of care in this facility was appalling. All patients -- all people -- deserve to be treated with dignity, and this was far from the case. The conditions were especially distressing given that in general they could be fixed or at least ameliorated relatively easily. Not all of the ills of old age or disability can be remedied, of course. Pain and fear will be present even with the best possible care. Given that this is true, all possible efforts must be made to reduce fear, anxiety, and pain to the greatest degree possible.
The facts that this report is based on were documented by…
Grant, P. (2010). Ethical lessons from the 'undercover nurse': implications for practice and leadership. Medical Ethics 36: 469-472.
Margaret Haywood's diary. Retrieved from http://news.bbc.co.uk/2/hi/programmes/panorama/4701651.stm .
Online bulletin. Retrieved from http://www.southerneditorial.co.uk/bulletin/july05/breaknews.htm.
Reasons for the substantive hearing of the Conduct and Competence. Retrieved from http://www.nursingtimes.net/Journals/1/Files/2009/4/17/haywood_NMCruling.pdf
person within the Christian worldview. Specifically it will discuss technology, the environment, and the media as it relates to my personal Christian worldview. As noted in this course, understanding a worldview can help a person understand other people and all their roles in today's society. Today's culture is broad, and influenced by a variety of sources, from scientific to religious, and they combine to create a contemporary Christian worldview in others and myself. Personally, my worldview is one of balance between my Christian beliefs and scientific study and analysis, which may be fairly common for a modern Christian worldview.
First, it is necessary to define worldview and what it is. A worldview encompasses every aspect of life, so understanding it is crucial in decision-making and living life to the fullest. It is really a wide-ranging perception of the world around us, formed using a Christian viewpoint. In other words, it…
Editors. (2009). About us. Retrieved 22 June 2009 from the Evangelical Climate Initiative Web site: http://christiansandclimate.org/about/ .
Gibson, T.S. (2004). Proposed levels of Christian spiritual maturity. Journal of Psychology and Theology, 32(4), 295+.
Holy Bible. New King James Version.
Schmeltekopf, D.D. & Vitanza, D.M. (Eds.). (2006). The future of Baptist higher education. Waco, TX: Baylor University Press.
Pangman and Seguire Journal Review
"Sexuality and the Chronically Ill Older Adult:
A Social Justice Issue"
"Sexuality and the Chronically Ill Older Adult: A Social Justice Issue" is an article by Verna C. Pangman and Marilyn Seguire, first published in 2000 in Volume 18 of the journal Sexuality and Disability. In their article, Pangman and Seguire provide a penetrating look at an issue all too often obscured by either false assumptions of unimportance, or perhaps mere squeamishness. The subtitle of their article makes it clear that Pangman and Seguire are approaching this issue from a political (if not indeed activist) standpoint: they seem particularly concerned that there is a sense of invisibility to the sex problems of the elderly, and a willingness to ignore those problems. They offer nurses a way of thinking about these issues.
Summary of Article
Pangman and Seguire begin by brushing away some of the myths…
Pangman, Verna C. And Seguire, Marilyn. "Sexuality and the Chronically Ill Older
Adult: A Social Justice Issue." In Sexuality and Disability, Volume 18
Number 1 (2000).
Area: Birmingham, AL
Educational requirements of the position
As in all states, the state of Alabama's requirements for certified case managers is that they work with ill and injured clients serving government agencies, healthcare facilities, courts and other service providers. Their job is to create a plan that will lay out the best kind of program for these clients and by so doing improving their physical and mental well-being.
Case managers in Alabama possess the minimal requirements of a bachelor's degree, with their major being in psychology, nursing, or health (as amongst other subjects). ome may carry on to a Masters in health, human or education services or a related field.
In Alabama, as in many states, case management nursing practitioners can also be licensed registered nurses and/or have an associate's degree in health or human services. Other requirements are interning at a clinic or other relevant organization…
al.com Registered Nurse Case Manager - Neurology (Full-time Days) - Brookwood Medical Center, Birmingham, AL
ccmcertification.org.Case Manager Certification www.ccmcertification.org.
EducationPortal.com Certified Case Manager Education Requirements and Career Info. http://education-portal.com/certified_case_manager.html
Tom Shulich ("ColtishHum")
A comparative study on the theme of fascination with and repulsion from Otherness in Song of Kali by Dan Simmons and in the City of Joy by Dominique Lapierre
In this chapter, I examine similarities and differences between The City of Joy by Dominique Lapierre (1985) and Song of Kali by Dan Simmons (1985) with regard to the themes of the Western journalistic observer of the Oriental Other, and the fascination-repulsion that inspires the Occidental spatial imaginary of Calcutta. By comparing and contrasting these two popular novels, both describing white men's journey into the space of the Other, the chapter seeks to achieve a two-fold objective: (a) to provide insight into the authors with respect to alterity (otherness), and (b) to examine the discursive practices of these novels in terms of contrasting spatial metaphors of Calcutta as "The City of Dreadful Night" or "The City of…
Barbiani, E. (2005). Kalighat, the home of goddess Kali: The place where Calcutta is imagined twice: A visual investigation into the dark metropolis. Sociological Research Online, 10 (1). Retrieved from http://www.socresonline.org.uk/10/1/barbiani.html
Barbiani, E. (2002). Kali e Calcutta: immagini della dea, immagini della metropoli. Urbino: University of Urbino.
Cameron, J. (1987). An Indian summer. New York, NY: Penguin Travel Library.
Douglas, M. (1966). Purity and danger: An analysis of concepts of pollution and taboo. New York, NY: Routledge & K. Paul.
Physician Assisted Suicide in Patients With Unbearable Suffering or the Terminally Ill
One of the most hotly debated issues today is physician-assisted suicide. ecently, California became the fifth state to legalize physician-assisted suicide, and there is an increasing likelihood that other states will follow suit in the foreseeable future. The purpose of this study is to determine if the factors chosen have any bearing on those who choose to end their life with physician assisted suicide. In support of this purpose, the objectives of this study were as follows: (a) to research scholarly articles regarding physician-assisted suicide and gather pertinent information into a comprehensive profile; (b) to research whether unbearable suffering is the dominant motive to request physician-assisted suicide; (c) to research whether the race and level of education of the patient are contributing factors when physician-assisted suicide is requested; and, (d) to research whether the type of terminal illness…
Bauer-Maglin, N. & Perry, D. (2010). Final acts: Death, dying, and the choices we make. New Brunswick, NJ: Rutgers University Press.
Biller-Adorno, N. (2013, April 11). Physician-assisted suicide should be permitted. The New England Journal of Medicine, 368(15), 1451.
Black's law dictionary. (1990). St. Paul, MN: West Publishing Company.
Boudreau, J. D. & Somerville, M. A. (2013,April 11). Physician-assisted suicide. The New England Journal of Medicine, 385, 15.
Euthanasia Should e Illegal
Euthanasia is the act of putting to death painlessly or allowing death, as by withholding extreme medical measures, a person or animal suffering from an incurable, often painful, disease or condition (Euthanasia, Infoplease.com). Today, medical advances have made it possible to prolong life in patients with no hope of recovery, and the term negative euthanasia has arisen to classify the practice of withholding or withdrawing extraordinary means (e.g., intravenous feeding, respirators, and artificial kidney machines) to preserve life. Positive euthanasia, on the other hand, has come to refer to actions that actively cause death such as administering a lethal drug.
Much debate has arisen in the United States among physicians, religious leaders, lawyers, and the general public over euthanasia (Euthanasia, Infoplease.com). Pro-euthanasia societies were founded in 1935 in England and 1938 in the United States. The Hemlock Society is one group that has pressed for right-to-die…
Active Euthenasia - A Kantian Perspective." PlanetPapers. 07 Dec. 2003. http://www.*****/Assets/1710.php.
Bopp, James, and Coleson, Richard. "The Constitutional Case Against Permitting Physician-Assisted Suicide for Competent Adults with "Terminal Conditions." Oregon Right to Life. 07 Dec. 2003. http://www.ortl.org/suicide/constitutional_case_2.html.
Burke, J. Balch and O'Steen, David N.. "Why We Shouldn't Legalize Assisting Suicide." National Right to Life Committee. 08 Dec. 2003. http://www.nrlc.org/euthanasia/asisuid4.html.
Chastain, Jane. (2003, Sept. 4). "Another 9-11 Date With Death." WorldNetDaily.com. 08 Dec. 2003. http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=34416 .
Anti) Right to Die
Science and technology has allowed humans to treat a myriad of diseases that were previously terminal. This is illustrated in the controversy over the case of Terry Schiavo, the Florida woman at the center of a right to die dispute between her husband and her parents.
Schiavo, who has been in a vegetative state for the past 13 years, brings a face to the legal question of when can a third party decide the fate of patients who cannot decide for themselves. According to Schiavo's husband, Terri would not want to live in her present state. Schiavo's parents, however, disagree (Stern and Goddard).
The conflict illustrates the lack of precedent regarding the legal status of patients like Terri Schiavo. There are many more like her, who are comatose, unconscious and with no hope of recovery. Science and technology has allowed humans to treat a myriad of…
American Foundation for Suicide Prevention. "Effective Pain Management Can Prevent Assisted Suicide." Suicide. Tamara L. Roleff, Ed. Opposing Viewpoints® Series. Greenhaven Press, 1998. Opposing Viewpoints Database.
Bresnahan, James. "Palliative Care or Assisted Suicide?" America, March 14, 1998. EBSCO database.
Emanuel, Ezekiel et al. "The Practice of Euthanasia and Physician-Assisted Suicide in the United States," Journal of the American Medical Association. August 12, 1998. EBSCO database.
Hendin, Herbert. Seduced by Death: Doctors, Patients and the Dutch Cure. New York and London: W.W. Norton and Company, 1997.
right to die. The writer uses analytical skills to dissect and argue several right to die cases that have been presented in court in America. The writer discusses the ethics of the practice as well as presents ideas about the future "right to die" arguments and cases. There were eight sources used to complete this paper.
Through the advances of medical science people are living longer than ever before. Those who are chronically ill are being helped in the quest to alleviate symptoms and those who might have become ill in the past are being cured. The medical science advances have also allowed those who would have died in the past from head injuries, car crashes, gun shots wounds and other accidents to live. All of the advances that have been made have worked in favor for millions of people who otherwise would have died. The advances are also providing…
Physician-Assisted Suicide: The Legal Slippery Slope (accessed 1-19-2003) from Cancer Control: Journal of the Moffitt Cancer Center
Cases in history (accessed 1-19-2003)
Death has always been shrouded in mystery, the constant litanies of myth, science, curiosity, magic, fear, and of course, religion. Just as myths have always wound down to the pragmatic, the real, and core accurate factual reporting - summarily losing the romantic, whimsical, and magical elements - so has the inevitability of human death.
Death is the central theme to life, vitality, order of society, and even powers - through the use of fossil fuels - our industry! When one, therefore, examines death objectively, he or she finds that death is a catalytic contract propelling the core beliefs and motivations of a group of people.
This evaluation seeks to isolate one aspect of death - euthanasia and a person's right to choose the time, place, and circumstance of their death without interference from legal, moral, religious, family, or other groups of social or punitive nature - and defend…
1974 The Euthanasia Society in New York renamed the Society for the Right to Die. The first hospice American hospice opens in New Haven, Conn.
1975 Deeply religious Van Dusens commit suicide. Henry P. Van Dusen, 77, and his wife, Elizabeth, 80, leaders of the Christian ecumenical movement, choose to die rather than suffer from disabling conditions. Their note reads, "We still feel this is the best way and the right way to go."
1975 Dutch Voluntary Euthanasia Society (NVVE) launches its Members' Aid Service to give advice
health care system has focused on the prevention and cure of disease and illness. When people got sick, every bit of energy and finances went into trying to figure out how to stop it. This was true even when the patient had a disorder or a disease that was deemed incurable. For many years when someone got a disease in which there was no cure, it did not change the method of treatment. The medical community, the family and the patient continued to try every possible avenue to stop the progress. Often times the patient would submit to painful and disorienting treatments, because they didn't want to disappoint their family members or their doctors. At the same time the medical community was expanding the length of life so that many people were living longer than ever before. These two things began to clash. At what point do people stop trying…
Public health system suffers from chronic underfunding http://home.aigonline.com/content/0,1109,16263-694-ceo,00.html
NEWS FROM AROUND AFRICA http://www.hospicecare.com/Newsletters/july2003/page8.html
Healthcare & Medical Market in Morocco http://www.tradepartners.gov.uk/healthcare/morocco/profile/overview.shtml
What is Hospice? http://www.hospicefoundation.org/what_is/
Importance of Physician Assisted Deaths
My Ethical Position on Physician Assisted Deaths as a Nurse
The Legal isks for Nurses
The Opposing View
Summary of Arguments in Favor of My Position
Importance of Physician-Assisted Deaths
Careful reflection is needed for physician-assisted deaths and euthanasia as they often always involve complex issues related to the family, the physician and the nursing staff. The critical question is about ethics that a nurse needs to follow when a patient asks for physician-assisted death. Also important are issues related to the personal professional values of the nursing staff. Though made legal in Canada, physician-assisted deaths still involve careful evaluation -- both medically and ethically, while deciding to agree to be a part of physician-assisted deaths. While there are several perspectives and often conflicting arguments to physician-assisted deaths, most agree that the issue of ethics is of prime importance while deciding on physician-assisted…
Chochinov, H. (2016). Physician-Assisted Death in Canada. JAMA, 315(3), 253. http://dx.doi.org/10.1001/jama.2015.17435
Downar, J., Bailey, T., & Kagan, J. (2014). Why physician-assisted death?. Canadian Medical Association Journal, 186(10), 778-779. http://dx.doi.org/10.1503/cmaj.114-0048
Landry, J., Foreman, T., & Kekewich, M. (2015). Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada. Health Policy, 119(11), 1490-1498. http://dx.doi.org/10.1016/j.healthpol.2015.10.002
Paterson, C. A History of Ideas Concerning Suicide, Assisted Suicide and Euthanasia. SSRN Electronic Journal. http://dx.doi.org/10.2139/ssrn.1029229
Government Regulations and Hospice
Government Regulations Affecting Health Care in Hospice
Regulations Affecting Health Care in Hospice
Impact of rules on Hospice services
This paper focuses on how government regulations impact hospice. The paper starts off with an introduction to the hospice system that was revived by a nurse, Cecily Saunders, who then went on to become a physician, establishing one of the first modern hospices. The concept of total pain is explained in some detail. The body of the paper then includes the studies that have been conducted on patients and caregivers in hospice systems as well as on people who died after they were diagnosed with terminal illness resulting in death in six months following the prognosis. The overall conclusion that can be drawn here is that while in Japan there is a marked need for improving the Day hospice system, the American hospice industry…
American Medical Directors Association. (n.d.). White Paper on Palliative Care And Hospice In Long-Term Care. Retrieved March 10, 2012, from American Medical Directors Association: http://www.amda.com/governance/whitepapers/palliative_care.cfm
Carlson, M.D., Morrison, R.S., Holford, T.R., & Bradley, E.H. (2007). Hospice Care: What Services Do Patients and Their Families Receive? Health Services Research, 42(4), 1672-1690.
Centers for Medicare & Medicaid Services. (2008). Medicare and Medicaid Programs: Hospice Conditions of Participation; Final Rule. Federal Register, 73(109), 32088-32220.
Christakis, N.A., & Escarce, J. j. (1996). Survival of Medicare patients after enrollment In hospice programs . The New England Journal of Medicine, 172-179.
Dying with dignity is a controversy argued in two perspectives by death scholars. Some scholars argue that dying with dignity is expiring without unnecessary physical pain while others argue that it is dying in the socially accepted ways. eaching these arguments was in light of changing health care demands and diverse customary practices. This controversy dated back to the ancient civilizations when many Greeks believed that taking one's life was better than experiencing endless suffering. This made physicians give poison to the terminally ill patients. However, with the advent of Christianity, the Hippocratic School that was against giving deadly drugs to patients acquired considerable acceptance. Therefore, euthanasia, as called in the fifteenth century was suicide and thus immoral. As time passed, reintroduction of the use of euthanasia continued, and it has even been largely accepted in various medical institutions.
In the perspective of dying with dignity as dying without any…
Beauchamp, T.L., & Childress, J.F. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.
Gentzler, J. (2003). What is a death with dignity? The Journal of Medicine and Philosophy, 28(4), 461 -- 487.
Poroch, N.C. (2012). Kurunpa: Keeping spirit on country. Health Sociology Review, 2i (4), 383-395.
Elephant in the oom Project is a research that was conducted for the purpose of improving the efficiency of care through effective and compassionate communication with palliative care patients. The research recognized that nursing is not only a science but also an art that requires the development of both aspects unlike the increased emphasis on the development of nursing science. As suggested by the definition of the art of nursing, the existence of effective caring requires the establishment of a trusting and therapeutic relationship between nurses and patients. Such a relationship can only be developed through effective communication that will enable the patients to view nurses as warm, genuine, and empathic professionals. In order to achieve its goals, the elephant in the room project consisted of evidence-based practice and use of various data collection strategies, methodology and sample.
In palliative care, communication acts as an important factor in…
Betcher, D.K. (2010, March/April). Elephant in the Room Project: Improving Caring Efficacy
through Effective and Compassionate Communication with Palliative Care Patients. MEDSURG Nursing, 19(2), 101-105.
"Communication." (n.d.). National Palliative Care Research Center. Retrieved March 6, 2012,
In North America most people die that can be called a bad death. A study found that "More often than not, patients died in pain, their desires concerning treatment neglected, after spending 10 days or more in an intensive care unit" (Horgan, 1996).
The term Euthanasia has originated from the Greek language: eu meaning "good" and thanatos meaning "death." However, according to the Netherlands State Commission, another meaning given to the word is "the intentional termination of life by another at the explicit request of the person who dies" (Netherlands State Commission).
Thus, the word euthanasia generally means that the person who wishes to commit suicide must commence the action. However, according to some people definition, euthanasia comprises both voluntary as well as involuntary execution of life. According to the moral, religious, ethical terms, the word "euthanasia" has many meanings, resulting in mass confusion. Therefore, it is vital…
Horgan, John. Right to Die. Scientific American, May 1996.
Netherlands State Commission on Euthanasia. Definition of Euthanasia.
DeathNet. Oregon Death With Dignity Act. http://www.rights.org/~deathnet/ergo_orlaw.html
Matas, Robert. Oregon Reconsiders Death-With-Dignity Law. The Globe and Mail Newspaper, Toronto ON, Nov 3, 1997 (p. A1)
As palliative care specialist Dr. Gilbert puts it, "Despite this close involvement with the very patients for whom euthanasia is advocated we do not encounter any persistent rational demand" [Southern Cross ioethics Institute]. The very point of 'Advanced Directives' is in itself confounding issue as frequently it is the patient's imaginary fears about loss of body functions and pain that drives them to such conclusions.
So it is cleanly obvious that in palliative care settings it is not uncommon for patients to succumb to momentary pain and wish for euthanasia but very rarely such requests are persistent. Instead of legalizing euthanasia, efforts must therefore be concentrated on improving the palliative care. This could take the form of improving pain control measures and providing loving and caring service to patients.
Legalizing Euthanasia (Implications)
Very few nations in the world have legalized euthanasia. Holland was the first country to do so and…
Eric Gargett, "Changing the Law in South Australia," World Right-to-Die
Newsletter, May 2001, p. 3. (a World Federation of Right to Die Societies
Richard a. Epstein, "Voluntary Euthanasia," Accessed on November 29th 2004, http://www.lse.ac.uk/clubs/hayek/Ama - gi/Volume1/number1/voluntary_euthanasia.htm
A person should always have the opportunity to die with dignity and perhaps even "discover the meaning of one's life" as pointed out by Pythia Peay.
At the very least, those that hold contrasting opinions on euthanasia should be able to come to an agreement that medical treatment must never be superseded by moral treatment. Even though the science of medicine is often highly specialized, it must never go against the moral ideals of the terminally-ill patient. Undoubtedly, there are many risks associated with euthanasia, but in the end, it should be the patient who decides. But in cases where the patient cannot respond nor make decisions, a living will appears to be the best solution, for this document clearly states the wants and desires of the person in case their lives turn for the worse and if they end up connected to a machine in order to stay alive,…
Athanaselis, Sotiris. (2002). "Asphyxial Death by Ether Inhalation and Plastic Bag Suffocation Instructed by the Press and the Internet." Internet. Vol. 4. Issue 3. Article e18. Journal of Medical Internet Research. Accessed May 1, 2005. http://www.jmir.org/
Brock, Dan W. (2002). "Physician-Assisted Suicide is Sometimes Morally Justified." Physician-Assisted Suicide. Ed. Gail N. Hawkins. San Diego: Greenhaven Press.
Euthanasia.com -- Definitions." (2005). Internet. Euthanasia.com. Accessed May 1, 2005. http://www.euthanasia.com/definitions.html .
e. incurable cancer; (2) referral to the Department of Palliative Medicine. The exclusion criteria for the study were: (1) estimated prognosis of less than 1 week; (2) significant cognitive impairment, i.e. unable to provide consent; (3) significant physical impairment, i.e. unable to complete protocol; (4) clinical evidence of dehydration; (5) current/recent (less than 2 weeks) use of antifungal medication. (Davies, railsford and eighton, 2005)
Davies, railsford and eighton (2005) report that the clinical component of the study involved "...completion of a study questionnaire (demographic data and clinical data), completion of the Memorial Symptom Assessment Scale, clinical examination of the oral cavity, measurement of the unstimulated whole salivary flow rate (UWSFR), measurement of the stimulated whole salivary flow rate (SWSFR), and performance of an oral rinse." ( p.698) The study results states that all patients/participants "...had either locally advanced, or metastatic cancer. The prevalence of different cancer diagnoses were: carcinoma breast…
Davies, Andrew N., et al. (2008) Oral Candidosis in Community-Based Patients with Advanced Cancer. Oral Candidosis in Advanced Cancer. Vol. 35, No. 5, May 2008. U.S. Cancer Pain Relief Committee.
Chang, AM, Molassiotis, A, Chan, CWH, and Lee, IYM (2007) Nursing Management of Oral Mucositis in Cancer Patients. Hong Kong Med J. Vol 13 No 1 Supplement 1 February 2007.
Alred, Michael J. (1991) Oral Health in the Terminally Ill: A Cross-Sectional Pilot Survey. Special Care in Dentistry, Vol 11 No 2, 1991.
Davies, Andrew N., Brailsford, Susan R. And Beighton, David (1991) Oral Candidosis in Patients with Advanced Cancer. Oral Oncology. 15 Sept 2005.
But there will also be situations where clinicians are asked to discuss with a patient whether they want to or should have resuscitation if they have had a cardiac arrest or life-threatening arrhythmia. The potential likelihood for clinical benefit in accordance with the patient's preferences for intervention and its likely outcome, involves careful consideration, as with many other medical decisions, in deciding whether or not to resuscitate a patient who suffers a cardiopulmonary arrest. Therefore, decisions to forego cardiac resuscitation are often difficult.
Cardiopulmonary resuscitation (CP) is a set of specific medical procedures designed to establish circulation and breathing in a patient who's suffered an arrest of both. CP is a supportive therapy, designed to maintain perfusion to vital organs while attempts are made to restore spontaneous breathing and cardiac rhythm (Braddock 2).
The standard of care is to perform CP in the absence of a valid physician's order to…
Braddock, C.H. (1998) Termination of life-sustaining treatment. University of Washington School of Medicine. Seattle: Department of Medical History and Ethics. Retrieved 3/12/07 at http://depts.washington.edu/bioethx/topics/termlife.html .
Frequently asked questions. (2007). The World Federation of Right to Die Societies. Retrieved at http://www.worldrtd.net/faqs/qna/?id=8 .
Guru, V., Verbeek, P.R. And Morrison, L.J. (1999). Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma. CMAJ. 61 Nov; 161(10).
Hilz, L.M. (1999). Psychology Terms: Transference and countertransference. Kathy's Mental Health Review. Riverside, CA: Mental Health. Retrieved at http://www.toddlertime.com/mh/terms/countertransference-transference-3.htm .
slippery slope argument is an argument that explains why it is best to err on the side of caution when an issue can become volatile if allowed to expand. The slippery slope argument is used to describe what can happen if the ball is allowed to roll on any controversial issue.
To understand how it would work in the Euthanasia debate one must first understand how the term came about. When one stands at the top of a hill, and begins to go down a slippery slope there is a chance that the person will lose their footing. Once that happens the person begins to gain momentum and often times bypasses the originally desired stopping point and ends up at the bottom of the hill and not commonly on their feet.
This argument can be applied to the Euthanasia argument that is such a hot topic in today's debates.
As a new graduate of six months working night shift on a small cancer unit, I am faced with a dilemma. Mr. V has been in and out of the unit several times over the last few months. He has liver cancer and has gone through several episodes of chemotherapy. His wife has been staying with him since his admission. There are two RN's on this unit.
Mr.V recently joined the hospice program. His current admission is for pain control with orders to start a morphine drip to be regulated for pain control.
The only set parameters indicated by hospital policy are to decrease the drip when respirations are less than twelve breaths per minute. Mr. V has requested that the drip be increased several times during my shift. Even though he does not appear to be in any discomfort, I increase the drip. On my final round of…
Strevy, S.S. Myths & facts about pain. RN, 42-45. 1998, February.
C. Junkerman and D. Schiedermayer, Practical Ethics for Students, Interns, and Residents, 2nd Ed, Frederick, MD: University Publishing Group, 1998.
American Nurses Association. Code for Nurses With Interpretive Statements. Kansas City, MO: the Association. 1985.
Strevy, S.S. (1998, February). Myths & facts about pain. RN, 42-45.
ethics prepared here, is based on two primary sources, (Callahan, 2012) and (achels, 2012). The article discusses the need to legalize and regulate voluntary active euthanasia in the United States (U.S.).
Can We eturn Death to Disease?
Callahan (2012) presents medical, moral and metaphysical perspectives to show the differences between active and passive euthanasia. He is of the notion that even though humans, through medicine, may be able to prevent death temporarily; there exist external factors that are beyond our control. Euthanasia refers to the act of painlessly putting to death individuals who are ailing from untreatable diseases or conditions. Some have referred to the act as a release from incurable, painful suffering. However, others argue that euthanasia initiated by a terminally ill patient as amounts to suicide. This is because it is the responsibility of physicians to treat and comfort their patients, not to use their medical expertise to…
Rachels, J. (2012). Active and Passive Euthanasia. Ultimate Issues in Current Nursing Ethics, 180-186.
Wolhandler, S. (1984). Voluntary Active Euthanasia for the Terminally Ill and the Constitutional Right to Privacy. Cornell Law Review, 363-383.
This is based on the theory, posed by citizens, that certain individuals afflicted with terminal illnesses should have the legal right to hasten their death.
As a result, individuals that acquire these disabilities often view death as an extremely viable solution.
The target population that the Oregon Death with Dignity statute involves are those that are terminally ill. There are both long and short-term effects of the statute on the rest of the population, as well as the target population. Oregon has the fourth highest rate of elder suicide in the United States, and the statute appears to be a short-term solution to a long-term problem. The statute gives physicians the long-term power to judge whether a particular suicide is rational, based on the physician's evaluation of the individual's quality of life. The short-term effect of the statute is that federal resources previously used to care for the elderly and…
Gil, D. (1976). A Framework and Synthesis of Social Policies. Unraveling Social Policy:
Theory, Analysis, Political Actions towards Social Equality. Cambridge, MA: 31-56.
Gil, D. (1992). Unraveling Social Policy. (5th Ed.) Rochester, VT: Schenkman.
This has sparked many debates in social and political arenas in regards to personhood, self-determination and human autonomy.
Any time a person wants to intentionally end his or her life, it is considered suicide. Suicide, in itself is now legal (Manning, 1998), but proponents of euthanasia argue that suicide may not be an option for the terminally ill, the hospitalized or physically disabled. These people may not have the strength or the means to end their lives alone, therefore, they cannot exercise the option of suicide and consequently are being discriminated against (Gifford, 1993).
I personally agree with those on the pro-euthanasia side of the camp, who believe that suicide is not an appropriate term for this issue because suicide is often associated with desperate emotion whereas euthanasia is based on a "cogent and deliberate form of relief from a painful and hopeless disease" (Adams, 1992). As opposed to suicide,…
Adams, Robert. "Physician-Assisted Suicide and the Right to Die With Assistance." Harvard Law Review 105:2021-2040, 1992
Gifford, Edward. "Artres Moriendi: Active Euthanasia and the Art of Dying." UCLA Law Review 40:1545-1583, 1993.
Manning, Michael, MD, Euthanasia and Physician-Assisted Suicide: Killing or Caring? Paulist Press, Mahwah, NJ, 1998
Olen, Jeffery & Barry, Vincent. Applying Ethics: A Text With Readings (6th ed.) Belmont, CA: Wadsworth Publishing Company, 1999.
Physically, massage or TT eases muscle tension and improves circulation. In turn, it improves digestion and breathing, enhances mental clarity, and encourages better sleep. TT is particularly useful to terminally ill patients in reducing or mitigating pain to the extent of making prescription painkillers unnecessary. Emotionally, TT or massage is a gentle and compassionate experience for the dying. It reduces the sense of isolation by providing him or her with physical connectedness. It can also re-establish dwindling or lost self-esteem and self-acceptance on account of disease. As a result, it contributes to increased quality of life and a much-needed release of emotions. Medicare as yet does not cover massage therapy for hospice settings but an increasing number of group have been lobbying for its inclusion.
Useful Alternatives to Pain and Discomfort Management
These alternatives have shown to be effective in easing spiritual, emotional and psychological pain that contribute to the…
Aghabati, N et al. (2010). The effect of therapeutic touch on pain and fatigue of cancer patients undergoing chemotherapy. Evidence-based Complementary Alternative
Medicine: PubMed. Retrieved on June 16, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887328
Catlin, A. (2009). Hospice massage: easing the pain of a life-limiting illness (Part 1).
vol 9 # 3, Massage Today: MPA Media Publications. Retrieved on June 19, 2011
Is physician-assisted suicide ethical if the patient requests medical assistance in terminating his or her own life?
In the U.S., the Supreme Court ruled in Washington v. Glucksberg (1997) that physician-assisted suicide is not protected by the Constitution. However, in other parts of the world, physician-assisted suicide is accepted socially and legally; and in the U.S., a patient who is terminally ill may engage in assisted-dying procedures, which are legal in six states and are legally differentiated from suicide (Buiting, Dieden et al., 2009). If one sets aside the legalistic parameters differentiating physician-assisted dying from physician-assisted suicide, can one say that the former is more ethical than the latter?
In other words, is physician-assisted suicide ethical if the patient requests medical assistance in terminating his or her own life?
In spite of what is permitted under the auspices of physician-assisted dying procedures, this paper will argue that…
Of course, as Medicare beneficiaries increase because of the number of baby boomers, the Medicare program may adjust. However, current hospice figures demonstrate that only about twenty percent of all elderly individuals that die are enrolled in hospice programs.
Implementation and Monitoring
The needs of this new program will require thorough training and once implemented, precise monitoring. "When you approach a problem in the way your work group functions, you're implementing an organizational change. By taking a critical look at your process, and using some theories from organizational design, you can fix the problem -- and change your organization to make quality more likely." (Derby, 1999) The training will be a key because of the potential requirements associated with the Hospice program that may require completely new skill sets for the majority of our staff. The fact is that many of our nurses may not have acquired the necessary skills…
Derby, Esther. (2002). Modeling Organizational Change. Retrieved on February 12, 2005, at http://www.estherderby.com/writings/modeling.htm
Hospice Benefits and Utilization in the Large Employer Market. Ed. Beth Jackson, Teresa Gibson, Joline Staeheli. March 2000. U.S. Department of Health and Human Services. Retrieved on February 12, 2005, from http://aspe.os.dhhs.gov/daltcp/Reports/empmkt.htm.
Rubenfeld, M. Gaie, & Scheffer, B.K. (1995). Critical Thinking In Nursing. Philadelphia: JB Lippencott.
Social Security Administration. (1993) "Social security programs in the United States." Social Security Bulletin 12/22/1993.
One solution of this issue can be that the closest most guardians is given the permission and right to take the decision about the life of the patient who is not able to communicate or express his wish. The guardian who should be responsible to take this decision should be the one who will be having direct impact of the death of the patient.
Community & Health Care esolution
Different communities have varied opinions in regard to right to die for geriatric. Although few of the countries have legalized this matter and have given the right to patient to decide whether he wanted to live more or not, but still there are campaigns in those countries that do not support the way patients should be given death and is also considered another way of committing suicide. Communities think if the right is legalized it will give doctors the right do…
Gastmans C. & Lemiengre. J. (2007). Development and communication of written ethics policies on euthanasia in Catholic hospitals and nursing homes in Belgium (Flanders), Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Belgium. Vol 63, Issue 1. pp 188 to 195, retrieved March 16, 2011 from http://web.ebscohost.com/ehost/detail?sid=06716113-81ca-4db0-a772-51ae3b6dd9ca%40sessionmgr15&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&an=2009306329
Kenny, R.W. (2007). An effect of communication on medical decision making: answerability, and the medically induced death of Paul Mills., Department of Public Relations, Mount Saint Vincent University. Vol 22, issue 1, pp. 69 -- 78, retrieved March 16, 2011 from http://web.ebscohost.com/ehost/detail?sid=c57afac0-3522-4bc8-8c8e-a0a7732261ee%40sessionmgr15&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&an=2009640106
Lemiengre K. (2008). How do hospitals deal with euthanasia requests in Flanders (Belgium)? A content analysis of policy documents. Health Promotion/Education, retrieved March 16, 2011 from http://web.ebscohost.com/ehost/detail?sid=37d04412-5a09-4727-92f0-398ccb54533a%40sessionmgr13&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&an=2009908744
Levett, C. (2011). Dying with dignity -- the case for end of life choices, Australian Nursing Journal, vol. 18, issue 8, pp. 48, retrieved March 16, 2011 from http://web.ebscohost.com/ehost/detail?sid=078d26de-de1f-4206-80ba-d37b9a51f264%40sessionmgr14&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&an=2010954963
Treatment to Patients
The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are…
Beekmann, SE;Diekema, DJ; Chapin, KC;Doern, GV (2003) Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J ClinMicrobiol, 41:3119-3125.
Boussekey, N, Leroy, O, Georges, H, Devos, P, d'Escrivan, T, Guery, B (2005).Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit.Infection, 33:257-263.
Charles, PE, Dalle, F, Aho, S, Quenot, JP, Doise, JM, Aube, H, Olsson, NO, Blettery, B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med, 32:1577-1583.
Digiovine, B; Chenoweth, C; Watts, C; Higgins, M (1999)The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J. RespirCrit Care Med, 160:976-981.
The nursing professional must be adept at dealing ith these kinds of conversations, and ithout increasing the guilt that the family member or patient might be experiencing, and keeping in mind the patient's probable depression; it is the responsibility of the nursing professional to take the conversation back to the treatment and therapies that ithin the realm of the legal and ethical practices in delivering medical nursing care.
Jacquie Peden, Darlene Grantham, and Marie-Josee Paquin (2005) say that nursing standards in palliative care are based on the values of the nursing profession, and are developed by provincial and territorial regulatory bodies in Canada to guide the professional practice of nursing professionals (p. 2). The hospice palliative nurse, they rite:
Believes in the intrinsic orth of others, the value of life, and that death is a natural process.
Establishes a therapeutic connection (relationship) ith the person and family through making, sustaining,…
works cited here support the need for continued and expanded research involving the different specialties in nursing and oncology to better serve patients and their families. Also, there is little nursing information that is found in the professional peer reviewed journals that speak directly to the issue of pancreatic patients and depression. There is much more literature on the subject from the physician and researcher perspectives, but there is a void in nursing literature. At this point in time, the depression of pancreatic patients as it concerns nursing, has received little attention. Both the nursing profession and pancreatic patients would benefit from further research in this area.
The conclusion from the study of the literature available is that not only is pancreatic patient depression not well understood, it is also lacking in research that would help professionals to address depression in these patients. Also, because it is directly linked to pancreatic cancer, and because the research does support the fact that patients suffering depression and pancreatic cancer do not enjoy the quality of life as those patients who do not suffer from depression, then pancreatic cancer patients and depression should be a distinct and separate therapeutic intervention from other groups of depression.
Adali, E., Merkouris a., Manoussou, E., and Priami, M. (2004). The Attitudes of General and Oncological Hospital Personnel toward Euthanasia, ICUS and Nursing Web Journal, 17:1-9, found online at http://www.nursing.gr/index1.html , retrieved 7 October 2009.
Canadian Nurses Association (2008). Position Statement: Providing Nursing Care at the End of Life, Canadian Nurses Association.
The aging brochure states, "Older workers, however, are more dependable, have lower turnover rates, have fewer absences and accidents, show better judgment, and are as productive as younger workers" (Schmall and Pratt, 1996, p. 8). His most productive time in promoting his cause came in his 60s and 70s, and he is still doing it at nearly 81 years of age, illustrating that older workers and older people in general, still have plenty of capabilities to work hard for what they believe in.
This exercise helps the student become more aware of the great gift of growing old and learning from your experiences. Dr. Kevorkian did not begin his work with PAS until well into his career, another indication of older adults being able to change, and his dedication to his cause is inspiring and educational at the same time. At age 80, he still travels the country…
Atwood Gailey, E. (2003). Write to death: News framing of the right to die conflict, from Quinlan's coma to Kevorkian's conviction. Westport, CT: Praeger.
Dr. Kevorkian and His Victims. (1996, August 24). The Washington Times, p. 12.
Gorsuch, N.M. (2000). The right to assisted suicide and euthanasia. Harvard Journal of Law & Public Policy, 23(3), 599.
Schmall, V., and Pratt, C. (1996). What do you know about aging? Pacific Northwest Extension.
Evidence, Evaluating Evidence, Making ecommendations
Life is a precious aspect of the human nature; the person has only one life to live. Therefore, it is essential for people to protect and guard the life of the individuals jealously. The nurses and other medical personnel do this work. The duty of the nurses is to care for all types of patients. However, the is a group of patients that require extra form of attention; this is the people that suffer from Terminal illnesses (Katz & Johnson 2006). Such people live with the reality of death in their faces. Dealing with such patients is quite difficult, and poses challenge to the nurses and the family of the individual who strive to facilitate the life of that patient. The nurses have difficulties in addressing the stressful nature of such people, as most of such patients lose interest in life. Additionally, the stress is…
Galbraithn .D. & Brownk .E. (2011) Assessing intervention effectiveness for reducing stress in student nurses: quantitative systematic review. Journal of Advanced Nursing 67(4), 709 -- 721. doi: 10.1111/j.1365-2648.2010.05549.x
Katz, R.S., & Johnson, T.A. (2006). When professionals weep: Emotional and countertransference responses in end-of-life care. New York: Routledge.
Herdman, T.H., & North American Nursing Diagnosis Association. (2008). NANDA-I nursing diagnoses: Definitions & classification, 2009-2011. Oxford: Wiley-Blackwell
Campbell, L.A., & ProQuest Information and Learning Company. (2009). Effectiveness of interventions in changing ICU nurses' attitudes and beliefs towards open/flexible visitation.
rise of advanced technologies in the medical field, especially those that sustains life, has brought issues in the ethics and morality of those involved in the field of medicine. Most significant to these issues is the practice of Euthanasia on patients diagnosed to have no chance of surviving and regaining life after any treatment has been implemented. In view of the issues on Euthanasia, this paper aims to present a discussion of this medical practice by analyzing the stands and views of Ned Cassem, James Rachel, Sidney Hook, and Leon R. Kass. This paper also aims to explain the meaning of "good death" as mentioned by Ned Cassem.
On many medical books and dictionaries, "euthanasia" or "mercy-killing" is defined as ending a life of a terminally ill patient by ways such as removing life support machines or stopping treatments that somehow prolongs life. The basic reason why euthanasia is performed…
Chung, Ken. On James Rachels and "Active and Passive Euthanasia."
Publish.Uwo.Ca. 28 Dec. 2002. http://publish.uwo.ca/~kchung23/rachels.htm
Hook, Sidney. "In Defense of Voluntary Euthanasia.."
The New York Times (1 Mar. 1987).
euthanasia and physician-assisted suicide on ReligiousTolerance.org, most people in North America die "a bad death," one characterized by pain, being unable to participate in their medical treatment program, or after spending over ten days in intensive care. A prevailing belief that any sign of life is preferable to death fuels arguments against the practice of voluntary euthanasia, distinguished from involuntary euthanasia in that the suicide is requested directly by the person in question. Euthanasia is one of the most controversial subjects in medial ethics today. On one side of the argument, organizations like the Hemlock Society have pushed for legislation that permits physician-assisted suicide (PAS). These efforts have met with a degree of success in the United States; in 1994 Oregon passed the Death with Dignity Act allowing PAS. However, there is even a distinction between voluntary euthanasia and PAS: with PAS, the physician simply provides the means with which…
Euthanasia and Physician-Assisted Suicide: Introduction." Religious Tolerance.org. http://www.religioustolerance.org/euth1.htm .
Gula, Richard. "Euthanasia and Physician-Assisted Suicide: Killing or Caring?" Christian Century. 5 May 1999. Online at Find Articles.com. http://www.findarticles.com/cf_0/m1058/14_116/54588537/p1/article.jhtml?term=euthanasia .
Leutwyler, Kristen. "In Cases of Euthanasia, Men Most Often Kill Women." Scientific American. 24 Sept 2001. Online at http://www.sciam.com/article.cfm?articleID=000B5030-819D-1C61-B882809EC588ED9F&catID=1 .
Right to Die
For the last few decades, the issue of a person's right to choose the time and method of his or her own death has been one of passionate debate in the United States, with emotions running high on both sides of the controversy as the meanings of liberty and freedom of choice, the morality of taking one's own life, the ethics of people involved in such actions, and the laws related to this issue take center stage in the arguments.
Since civilization began, suicide has existed in one form or another, with varying degrees of acceptance, such as the ancient Greeks who held tribunals for elderly people who requested to die, and if approved, were given hemlock and during the first century B.C. actually held annual banquets where the elderly were allowed to attend and drink poison if they felt they had lived long enough.
Brennecke, Shari J. "Right to Die: An Overview" Gerontology Manual. http://otpt.ups.edu/Gerontological_Resources/Gerontology_Manual/Brennecke.html .(accessed 12-03-2003).
Chachere, Vickie. "Judge appoints professor as guardian for brain-damaged woman in Florida." AP Worldstream. November 01, 2003. http://ask.elibrary.com/getdoc.asp?querydocid=1P1:86544618&dtype=0~0&dinst=0&pubname=AP+Worldstream&author=VICKIE+CHACHERE%2C+Associated+Press+Writer&title=Judge+appoints+professor+as+guardian+for+brain%2Ddamaged+woman+in+Florida&date=11%2F01%2F2003&query=Terry+Schiavo+and+the+State+of+Florida%2E&maxdoc=30&idx=2&ctrlInfo=result%3ASR%3Aprod.(accessed 12-03-2003)
Cruzan v. Director, Missouri Dept. Of Health." Citation: 497 U.S. 261 (1990)
Concepts: Right to Die/State Police Powers. http://www.tourolaw.edu/patch/CaseSummary.html .(accessed 12-03-2003).
Fact sheet on end-of-life care. American Psychological Association. http://www.apa.org/pi/eol/factsheet1.pdf
Fact sheet on end-of-life care, published by the American Psychological Association discusses the adult's mental health needs near the end of life and the obstacles they confront to having a comfortable death.
Foley, K.M., (1995). Pain, Physician assisted dying and euthanasia. Pain 4, 163-178.
Foley discusses how access to and delivery of pain treatment are seriously deficient in the present health care systems in the United States. The author advocates expanding services and resources to care for the dying patient.
Isaacs, S.L. And Knickman, J.R (1997). To improve health and health care. San Francisco, CA: Jossey ass.
Isaacs and Knickman examine programs of the Robert Wood Johnson Foundation, a health care philanthropy. They reports its history, evaluates its effect, and discusses lessons learned as well as provide a frank discussion of why some problems can't be easily solved.
Langer, G. (2003,…
Bernstein, S. (1997, September 30). An act of mercy or murder?
Bernstein includes opinions (both pro and con) on whether services be available to any patient who is terminally ill and facing certain death within six months.
Coleman, C.H. And Miller, T.E. Stemming the tide: Assisted suicide and the Constitution. http://law.shu.edu/faculty/fulltime_faculty/colemaca/pdf_docs/coleman_miller_watermark.pdf
Certainly in nature, one who was too ill to move would not last long. They would certainly not be placed on a feeding tube, having a machine breathing for them, mechanical devices doing all but forcing their heart to beat. Does having the power to extend life mean that physicians then have a duty to do so? According to Lachs, "Medicine does not surrender its vocation in serving the desires of individuals: since health and continued life are among our primary wishes, its career consists in just this service." If the primary duty of a physician is to honor their patient's wishes for health, then if a patient desires death as an end to suffering, that physician does not have a duty to prolong that patient's life. Rather, prolonging life against the wishes of the patient breaches the duty of the profession.
hy, then, do physicians continue to take incredible…
"Ethics." Internet Encyclopedia of Philosophy. 19 March 2011.
The Hippocratic Oath; Modern Version. PBS.com. 19 March 2011.
Lach, John. "When Abstract Moralizing Runs Amok." (please insert the book information, as it was not on the pages sent)
Singer, Peter. "Voluntary Euthanasia: A Utilitarian Perspective." (see note, above)
Analytical and Interpretative Preciseness
The small number of participants and open-endedness of the focus groups also led to a degree of imprecision in the analysis and interpretation of the study's results, but this was expected and even sought to a degree by the researchers (Johansson et al. 2006). One of the primary findings of the study was "that the patients used individual strategies to relive pain by emotional and physical distractions," and this is only a base indicator of the individualism expressed by the five participants (Johansson et al. 2006). On the other hand, there was enough agreement among the participants for the researchers to determine five distinct themes around which the discussion in the focus groups revolved, providing perhaps more prescision in the results than hoped for.
Philosophical and Theoretical Connectedness
Throughout this research article, the theoretical and philosophical connections of the study to the larger practice of medicine…
consent embodies the idea that as a matter of ethics and law patients are entitled to be exposed to all of the relevant information that would influence and guide their decision making concerning what treatment that they should follow. However, should clinicians provide medical information to terminally ill patients when they suspect that such information could potentially be used to facilitate their suicide? The issues surrounding full disclosure, beneficence, and therapeutic privilege as they relate to patients and their families are discussed and recommendations regarding how such cases should be conceptualized are discussed.
Should clinicians provide medical information to terminally ill patients when they know or suspect that such information will be used to facilitate their suicide? This dilemma affects patients, their families, physicians, other medical professionals. The notion of "informed consent" as a guiding principle in medicine is at the center of modern professional medical ethics. Informed consent embodies…
Monagle, J.F. (1998). Health care ethics: Critical issues for the 21st century. Gaithersburg, MD: Aspen Publications.
Paterick, T.J., Carson, G.V., Allen, M.C., & Paterick, T.E. (2008). Medical informed consent: General considerations for physicians. Mayo Clinic Proceedings, 83(3), 313-319.
Russell, B.J. & Ward, A.M. (2011). Deciding what information is necessary: Do patients with advanced cancer want to know all the details? Cancer Management and Research, 23, 191-199
Shatz, D. (1986). Autonomy, beneficence and informed consent: Rethinking the connections. I. Cancer Investigation, 4, 257-269.
Both doctors feel physician-assisted suicide is a compassionate alternative to living the remainder of life filled with pain and suffering. Many others agree, and there are even published documents instructing loved ones and physicians how to go about assisting in a death with dignity suicide. In fact, many physicians feel that physician-assisted suicide could help keep health care costs in check as the baby-boomer generation ages. Unfortunately, statistics are lacking in the area of terminally ill patients and how many would end their lives if given the choice. Statistics do show, however, that many physicians receive requests for medications that will hasten death, or requests for lethal injections, and that a small number to comply in some cases.
Many physicians oppose the practice because they feel it goes against the oath they took to always save lives, while some do sympathize with terminally ill patients. here are also similar considerations…
Two of the most well-known advocates of physician-assisted suicide are Dr. Jack Kevorkian and Dr. Timothy Quill. Moral conservatives oppose euthanasia because they believe it is morally wrong, and is the same as ending life-sustaining treatment. Both doctors feel physician-assisted suicide is a compassionate alternative to living the remainder of life filled with pain and suffering. Many others agree, and there are even published documents instructing loved ones and physicians how to go about assisting in a death with dignity suicide. In fact, many physicians feel that physician-assisted suicide could help keep health care costs in check as the baby-boomer generation ages. Unfortunately, statistics are lacking in the area of terminally ill patients and how many would end their lives if given the choice. Statistics do show, however, that many physicians receive requests for medications that will hasten death, or requests for lethal injections, and that a small number to comply in some cases.
Many physicians oppose the practice because they feel it goes against the oath they took to always save lives, while some do sympathize with terminally ill patients. There are also similar considerations for nurses and pharmacists who might be involved in the assisted suicide. The most famous proponent of physician-assisted suicide is Dr. Jack Kevorkian, now serving a prison sentence for the practice in Michigan.
The Supreme Court has upheld Oregon's right to die act, while striking down other rulings in other states. Their latest decision recognizes this is a state issue, rather than a federal one. The Oregon Act originated in 1994, and was finally passed in 1997. Since then, it has undergone several legal challenges, but continues to be upheld in the courts. It is interesting to note that in an Oregon study, not everyone who requests a lethal dosage of medication actually ingests the medication and dies. Some choose to keep their lethal dosage, and some die before they can use it. The numbers of requests for lethal doses each year have remained stable, as well.
In this case, there would be little benefit to society as compared to the individual's right to be free from pain and to make autonomous decisions. According to Singer's utilitarianism, euthanasia is therefore the ethical choice.
Sarah Banks writes on the practical application of these ethics, with a special focus on the caring professions. For Banks, codes of ethics are not rigid rulebooks with prescriptions on the minutiae of professional practice. This thus opens the possibility that there are cases where social workers could find euthanasia to be the ethical choice, such as cases of extreme pain and suffering for terminally ill patients.
Since euthanasia is largely a question of morality and ethics, addressing this question through legislation will do little to quell the debate. The only certainty is that as science continues to advance, society will continue to grapple with the moral questions raised by…
Nursing & Humanities, Alice Munro
SLIDES FOR A PRESENTATION OF HUMANTIES AND NURSING: CHRONIC AND TERMINAL CARE ISSUES PRESENTED IN ALICE MUNRO'S "THE DAY OF THE BUTTERFLY," BELLE & SEBASTIAN'S "IT COULD HAVE BEEN A BRILLIANT CAREER," AND TONY KUSHNER'S "ANGELS IN AMERICA"
"The Day of the Butterfly" by Alice Munro is a quiet portrayal of elementary schoolgirls in 1950s Canada learning one of their classmates has a terminal illness.
"It Could Have Been A Brilliant Career" performed by Belle and Sebastian is a song about a young stroke victim and his caregiver.
"Angels in America" is a television-film adaptation of the Pulitzer-Prize-winning play by Tony Kushner, and depicts the AIDS epidemic in 1986 before any cure or medication had been discovered.
From the standpoint of a professional Nurse, these artistic depictions of terminal and end-of-life illness teach us emotional lessons about the experience of survivors -- they ask…
One of the most controversial debates to concern the medical profession in recent decades is that of 'physician-assisted suicide, or active euthanasia. The very mention of the word 'euthanasia' arouses strong emotions and opinions, both in favor and in opposition. Yet, among the multitude of issues and complex arguments that surround the debate, there is one fundamental human right that must be acknowledged: the individual, and not society, has ultimate control over his/her future. Of course, when applied to the issue of active suicide, the individual relies on the assistance of a physician in carrying out his/her personal wishes, and it is this physician-assistance that draws a great deal of criticism from opponents. However, with many of the arguments against active suicide being centered upon the area of regulation and potential abuse, then not only 'should' physicians be allowed to provide their assistance, but indeed they 'must'. In…
Brock, W., Dan, (1992). Voluntary Active Euthanasia. Hastings Center Report, March/April, 11-12, 14-17, 19-21.
Nurse, Must I always tell the truth
Truth in nursing fraternity
"I think it's difficult for many physicians and nurses to be completely truthful about their patients' medical condition. I believe we prefer giving positive news because of the desire for nonmaleficence and to avoid the stress of delivering bad news to patients and their families" (Crystal Hird, 2005).
Despite the grave sadness that truth saying within the nursing practice may bring to the nurse or the patient and at times the family members, there is need to have the truth told at all times by the nurse and truth that is handled with absolute care and professional communication system must be followed.
This paper is purely based on the value of truth in nursing and the virtue of nurse telling the truth despite the situation. It will also look at how the truth needs to be told in the…
Crystal Hird, (2005). Letters to the Editor: A Call for Education. Nursing Ethics. Edward Arnold Publishers Ltd.
Kate Hodkinson, (2008). How should a nurse approach truth-telling? A virtue ethics perspective.
Nursing Philosophy. Blackwell publishers. Pp 249
Neelam S. (2013). Truth Telling to Terminally Ill Patients: To Tell or not to Tell. Journal of Clinical Research and Bioethics. Vol4. Issue 4. Retrieved March 7, 2014 from http://www.google.co.ke/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0CGIQFjAG&url=http%3A%2F%2Fwww.omicsonline.org%2Ftruth-telling-to-terminally-ill-patients-to-tell-or-not-to-tell-2155-9627-4-159.pdf&ei=CNoZU8rHJdSy7Aai8YCQCg&usg=AFQjCNGZBSh9Kojp9XIPVHuKZIIQ0tPKyQ&sig2=BN5Na2a9YVp5t7gV6oonOQ&bvm=bv.62578216,d.bGE