Institutional ethics policies on medical end-of-life decisions: A literature review

Lemiengre, Joke; Casterlé, Bernadette Dierckx de; Craen, Katleen Van; Schotsmans, Paul; Gastmans, Chris

doi:10.1016/j.healthpol.2007.02.013

Cited by 46 publications

(34 citation statements)

References 57 publications

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“…Besides, institutional written ethics policies on artificial food and fluid administration could aid and support nurses in clinical-ethical decision making. However, Lemiengre et al 58 reported that very few nursing homes and hospitals (<7%) have written ethics policies on artificial nutrition and hydration. Clinical practice guidelines developed by professional organisations or academics and institutional ethics policies can help build consensus among caregivers.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature

2008

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Section: Discussionmentioning

confidence: 99%

Nurses’ attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature

2008

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“…We based our sample size calculation on the large range in prevalence of DNR orders reported in the literature and clinical experience, and we estimated 750 patients would provide an acceptable confidence interval of ±3.5% around the expected sample prevalence of DNR orders. 15 We collected data from the ED electronic medical record (ED PulseCheck, Picis, Inc., Wakefield, MA) and the hospital electronic medical record (eResults, Lakeland HealthCare, St. Joseph, MI) via chart review. The complete electronic medical record for the identified visit and hospitalization (if applicable) as well as any information from the previous month were assessed.…”

Section: Methodsmentioning

confidence: 99%

152: Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department

Wall¹,

Hiest²

2009

Annals of Emergency Medicine

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Introduction:We conducted an epidemiologic evaluation of advance directives and do-notresuscitate (DNR) prevalence among residents of extended care facilities (ECF) presenting to the emergency department (ED). Methods:We performed a retrospective medical record review on ED patients originating from an ECF. Data were collected on age, sex, race, triage acuity, ED disposition, DNR status, power-of attorney (POA) status, and living will (LW) status. We generated descriptive statistics, and used logistic regression to evaluate predictors of DNR status.Results: A total of 754 patients over 20 months met inclusion criteria; 533 (70.7%) were white, 351 (46.6%) were male, and the median age was 66 years . DNR orders were found in 124 (16.4%, 95% CI [13.9-19.1%]) patients. In univariate analysis, there was a significant difference in DNR by gender (10.5% female vs. 6.0% male with DNR, p=0.013), race (13.4% white vs. 3.1% nonwhite with DNR, p=0.005), and age (4.0% <65 years; 2.9% 65-74 years, p=0.101; 3.3% 75-84 years, p=0.001; 6.2% >84 years, p<0.001). Using multivariate logistic regression, we found that factors associated with DNR status were gender (OR 1.477, p=0.358, note interaction term), POA status (OR 6.612, p<0.001), LW (18.032, p<0.001), age (65)(66)(67)(68)(69)(70)(71)(72)(73)(74) p=0.478;(75)(76)(77)(78)(79)(80)(81)(82)(83)(84) p=0.091, >84 years OR 5.258, P<0.001), with interactions between POA and gender (OR 0.294, P=0.016) and between POA and LW (OR 0.227, p<0.005). Secondary analysis demonstrated that DNR orders were not significantly associated with death during admission (p=0.084). Conclusion:Age, gender, POA, and LW use are predictors of ECF patient DNR use. Further, DNR presence is not a predictor of death in the hospital. [West J Emerg Med. 2015;16(7):966-973.]

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“…Only Dutch and Belgian Institutions dealt with policies on euthanasia, and it was found that in these, significant consideration was given to procedures that dealt with conscientious objections of physicians and nurses [71].…”

Section: Healthcare Policy Implementationmentioning

confidence: 99%

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Human and Veterinary Medicine

Eyre-Pugh¹,

Yeates²

2017

Preprint

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Not a lot is known about either death or the dying process. Politicians and the medical profession in the UK tend to shy away from interfering with it by not allowing euthanasia as an end of life option for the patient. This is the first paper in a series of two, comparing the situation in human medicine and veterinary medicine, in which euthanasia is well practiced for relieving suffering at the end of life. This first part takes the form of a literature review including best practice around end of life care, its deficiencies and the need for assisted dying. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. In countries which have legalized physician assisted suicide for the terminally ill reporting indicates that it works well, without increases in involuntary euthanasia and most importantly without intimidation of the vulnerable. However, there is still an ever increasing tendency to overuse sedation and opioids at the end of life, which merits further investigation. With advances in medical science able to significantly prolong the dying process, patient autonomy demands a review of the law in the UK.

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Institutional ethics policies on medical end-of-life decisions: A literature review

Cited by 46 publications

References 57 publications

Nurses’ attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature

Nurses’ attitudes towards artificial food or fluid administration in patients with dementia and in terminally ill patients: a review of the literature

152: Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Human and Veterinary Medicine

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