Tuesday, 21 April 2009

Articles from Critical Care Medicine

Link to full text of journal
Crippen, David MD, FCCM
Palliation for high-risk patients: Should we be watching? .[Editorial]
Critical Care Medicine. 37(4):1498-1499, April 2009.

Whetstine, Leslie M. ; Crippen, David
Shortening the dying process: More than a feelin' .[Editorial]
Critical Care Medicine. 37(4):1489-1490, April 2009.

Song, Mi-Kyung ; De Vito Dabbs, Annette ; Studer, Sean M. ; Arnold, Robert M. Palliative care referrals after lung transplantation in major transplant centers in the United States
Critical Care Medicine. 37(4):1288-1292, April 2009.
Objective: Although lung transplantation is a widely used treatment modality for patients with end-stage lung disease, its long-term outcomes are limited. Including palliative approaches in the care of lung transplant recipients may be beneficial; however, systematic information regarding the utilization of palliative care services for lung recipients is lacking.Design and Setting: Of the 27 transplant centers meeting the inclusion criteria (an annual lung transplant volume >=15 for the past 5 years and the availability of palliative care or pain services at the center), 74 clinicians representing either the transplant or palliative care program from 18 centers completed surveys.Results: Both transplant and palliative care clinician respondents strongly favored the idea of integrating palliative care into lung transplant care. However, the number of palliative care referrals made during the last year was low (<=5 per center). The three most frequently endorsed reasons for palliative care referrals were end-of-life planning, uncontrolled pain and symptoms, and limited functional status. The average length of survival after referral was <30 days. Palliative care clinicians considered misconceptions that palliative care meant "end-of-life care" as a major barrier, whereas transplant clinicians identified uncertainty about recipients' prognoses, the perception that palliative care precludes aggressive treatment, and difficulty in discussing palliative care with recipients and family as barriers.Conclusions: Despite clinicians' positive attitudes toward integrating palliative and lung transplant care, actual utilization of palliative care services is low. Collaborative efforts to enhance communication between the two programs are needed to clarify misconceptions and promote understanding between the programs.(C) 2009 Lippincott Williams & Wilkins, Inc.

Manthous, Constantine A.
Why not physician-assisted death?
Critical Care Medicine. 37(4):1206-1209, April 2009.
Objective: The Hippocratic Oath states "[horizontal ellipsis] I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect" ( http://en.wikipedia.org/wiki/Hippocratic_Oath). Physician-assisted suicide and euthanasia are topics that engender a strong negative response on the part of many physicians and patients. This article explores contributions of religion, Western medical mores, law, and emerging concepts of moral neurocognition that may explain our inherent aversion to these ideas.Sources: Religious texts, legal opinions, manifestos of medical ethics, medical literature, and lay literature.Conclusion: Our collective repudiation of physician-assisted death, in all its forms, has complex origins that are not necessarily rational. If great care is taken to ensure that a request for physician-assisted death is persistent despite exhaustion of all available therapeutic modalities, then an argument can be made that our rejection constrains unnecessarily the liberty of a small number of patients.(C) 2009 Lippincott Williams & Wilkins, Inc.

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