Proper care for the dying: a critical public issue.

Crispell, Kenneth R.; Gomez, Cristina

doi:10.1136/jme.13.2.74

Cited by 7 publications

(2 citation statements)

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“…All data seem unreliable, but like equality in Orwell's Animal Farm, some data seem more unreliable than others. Having said that there seems at least anecdotal evidence to support the quotation from Crispell and Gomez (1987)' that "Eighty per cent of the health care dollar is consumed by 13 per cent of the population of which half the patients are over 65 and on Medicare. The single most expensive medical bill is for the last week of life of a patient terminally ill in an acute care hospital."…”

Section: Statesmentioning

confidence: 99%

A Personal View of Future Trends

Wilkes¹

1988

Annals of the New York Academy of Sciences

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I thought it would be helpful at this final stage of the Conference to discuss briefly one or two areas to which more time could perhaps have been helpfully allocated. First, however, I would like to make some general comments.It seems clear that the British physicians here have a more public shortage of facilities and resources than their American colleagues and yet, although under considerable threat, the British have for the time being been able to retain an independence of action and a freedom from restriction that their American colleagues, practising in the land of the free, openly envy. Why is this?Physicians on both sides of the Atlantic deprecate the dead head of bureaucracy from whatever source. The British system of socialised medicine-the National Health Service (NHS) -seems to be far less restrictive and hidebound than the American system. To British eyes the American health care system has all the disadvantages and none of the advantages of a state system. Rational coordination of scarce resources cannot even be attempted.Disgruntled greed is not unique to the Medical Profession but should be controllable without too much trouble in the next decade. During that time medical funding is going to get scarcer on both sides of the Atlantic. The population is ageing on both sides, too. Private hospitals, contracting in the USA but still optimistically expanding in Britain, will reach a plateau, not without trauma, in the next few years. Day-surgery, day-care, very short-term admissions to the acute wards will become the norm, destroying or threatening patient-nurse relationships through the sheer rapidity of throughput. The system will ignore even more assiduously than in the past the longterm supportive needs of the chronic sick or disabled while gaining fulsome and to some degree appropriate praise from cost-conscious administrations. PRIVATE MEDICINE IN BRITAINIt is an era when the market-place for private medicine is expanding rapidly in Great Britain. This is especially so for the elective surgery that the NHS does adequately but when it suits the NHS and not the patient, so that herniorrhaphies or prostatectomies or hip arthroplasties may wait for months although the breast lump only waits for days.The British physician looks askance at private medicine for two reasons. First, it steals away NHS-trained scarce skills and second and far more serious, it delivers more luxurious but worse care for wealthy (and not so wealthy) patients in trouble.The private nursing blocks of famous teaching hospitals are more famous for the temporary employment opportunities they offer to overseas nurses than for the quality of their care. Further, the private sector in Britain is as profligate of resources as American or Australian medicine at their most wasteful! 167

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Section: Statesmentioning

confidence: 99%

A Personal View of Future Trends

Wilkes¹

1988

Annals of the New York Academy of Sciences

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“…In recent years, there have been a number of studies conducted and articles written on issues concerning the withdrawal of life support (Bedell & Delbanco, 1984;Cohen, 1982;Crispell & Gomez, 1987;Emanuel, 1988;Finucane, Shumway, Powers & D'Alessandri, 1988;Haug, 1978;Johnson and Justin, 1988;Lo & Jonsen, 1980;Meisel et al, 1986;Pinkus, 1984;Ruark et al, 1988;Shmerling, Bedell, Lilienfeld, & Delbanco, 1988;Stephens, 1986;Wanzer et al, 1984;Wanzer et al, 1989;Younger et al, 1985;Zimmerman et al, 1986), including the seminal report prepared by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, "Deciding to Forego Life-Sustaining Treatment" (1983). Crispell and Gomez (1987) defined terminal illness as "a state of disease characterized by progressive, irreversible deterioration, with impairment of function and survival limited in time" (p. 74). The ability of the medical profession to prolong the dying process has created the current, confusing situation for all concerned: The patient, his or her family, and the medical care team itself.…”

Section: Time To Quit: Bioethical Issuesmentioning

confidence: 99%

Humanizing death: Psychotherapy with terminally ill patients.

Levy¹

Psychological Aspects of Serious Illness: Chronic Conditions, Fatal Diseases, and Clinical Care.

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was awarded the PhD in clinical psychology from lndiana University at Bloomington in 1975. She received the Distinguished Doctoral Dissertation Award from the American Psychological Association (Division 12) for her doctoral research on schizophrenia.Levy's major interest over the last several years has been in examining the role that behavior plays as a biological response modifier relevant to disease end points, both cancer risk and progression, as well as infectious sequelae in essentially healthy populations. She has been particularly interested in studying aspects of the immune system and the effects of central nervous system input on various types of lymphocytes, relevant to tumor control or spread. More generally, as a behavioral scientist, she has written extensively about behavior as it contributes to cancer control.Levy is the author of Behavior and Cancer: Life-style and Psychoso-cia1 Factors in the Initiation and Progression o f Cancer. She has also 187 Copyright American Psychological Association. Not for further distribution. HUMANIZING DEATH:PSYCHOTHERAPY WITH TERMINALLY ILL PATIENTS 'Because of limitations of space in this chapter, I will not consider the rather large collection of psychological literature on the perceptions of death and dying, death anxiety, attitudes toward death, and the like. Rather, this chapter will have a distinctly clinical, therapeutic focus, with a major emphasis on the psychologist as part of the health care delivery team in a medical or hospice setting. Also, because of space constraints, the focus will be primarily on adult, rather than pediatric, patients.

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Medizin

Gerlach¹,

Hannich²

1996

Sterben Und Tod

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Proper care for the dying: a critical public issue.

Cited by 7 publications

References 1 publication

A Personal View of Future Trends

A Personal View of Future Trends

Humanizing death: Psychotherapy with terminally ill patients.

Medizin

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