The practice of terminal discharge: Is it euthanasia by stealth?

Krishna, Lalit Kumar Radha; Murugam, Vengadasalam; Quah, Daniel

doi:10.1177/0969733016687155

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…Yet the Individual Ring is also informed by psycho-emotional, experiential, perceptual, and contextual considerations; individual preferences and decision-making styles and biases; and prevailing professional, sociocultural, legal, ethical, and personal considerations. The Individual Ring reveals the evolving and context specific nature of concepts of dignity [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic scoping review on patients’ perceptions of dignity

et al. 2022

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Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool.

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Section: Introductionmentioning

confidence: 99%

A systematic scoping review on patients’ perceptions of dignity

et al. 2022

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“…This situation was defined in studies as a type of discharge against medical advice (DAMA). Both automatic discharge and DAMA have been investigated by many studies on the types, causes, and trends of discharge and their impacts on patient outcomes and hospital strategies ( 1 – 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…In China, many patients want to be home for their last moments of life. Therefore, some patients who are automatically discharged are terminally discharged, which means that the patients are in critical condition and were likely to pass away within a few hours or days before discharge ( 1 ). The rate of terminal discharge in the ICU (intensive care unit) is approximately 2.87–8.9%.…”

Section: Introductionmentioning

confidence: 99%

“…If the patients’ diagnosis and treatment data were included in the survival group for analysis, the results would be altered. In particular, most ICU patients are critically ill, and the proportion of terminally discharged patients is higher in the ICU than in other general departments ( 1 ), this results in a greater interference in the survival group data that could affect the results of the data analysis. Therefore, such patients should be identified in advance, and their medical data should be treated accordingly.…”

Section: Introductionmentioning

confidence: 99%

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There Is a Third Condition Aside from Survival and Death that Affects Outcome Statistics: Terminal Discharge

Xu¹,

Chen²,

Wang³

et al. 2021

ijph

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Background: Some patients discharged automatically are classified as terminal discharge, while their clinical outcome is survival, disrupting the results of clinical research. Methods: The data of this study were taken from inpatients admitted to the ICU of the First Medical Center of the People's Liberation Army General Hospital, Beijing, China from 2008-2017. We collected the data regarding medications used over the three days before discharge from the group of patients who survived and the group of patients who died, and the outcomes of all patients were recalculated by three classification algorithms (AdaBoosting, Pearson correlation coefficient, observed to expected ratio-weighted cosine similarity). Our basic assumption is that if the classification result is death but the actual in-hospital outcome is survival, the associated patient was likely terminally discharged. Results: The coincidence rate of the outcomes calculated by the AdaBoosting algorithm was 98.1%, the coincidence rate calculated by the Pearson correlation coefficient was 61.1%, and the coincidence rate calculated by the observed to expected ratio-weighted cosine similarity was 93.4%. When the three classification methods were combined, the accuracy reached 98.56%. Conclusion: The combination of clinical rules and classification methods has a synergistic effect on judgments of patients’ discharge outcomes, greatly saving time on manual retrieval and reducing the negative influence of statistics or rules.

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“…To advance thinking on the matter and better capture the effects of caring for terminally ill children in the PPC, a more responsive concept capable of capturing individual perspectives of personhood over time and in diverse settings is required. The Ring Theory of Personhood (RToP), 4,34 -47 an evidenced based tool used to characterize changes to self-concepts of personhood among Palliative Care patients is thus proposed. 2 -6,34,35,45 The RToP 4,34,35,45 consists of 4 concentric rings that correspond to the Innate, Individual, Relational and Societal Ring (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review

Ngiam

Ong

et al. 2020

Am J Hosp Palliat Care

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Introduction: Caring for terminally ill children influences nurses’ and allied health provider’s quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician’s concept of personhood is affected caring for terminally ill children in order to better support them holistically. Methods: Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis. Results: 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician’s professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors. Conclusion: Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician’s personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.

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The practice of terminal discharge: Is it euthanasia by stealth?

Cited by 7 publications

References 39 publications

A systematic scoping review on patients’ perceptions of dignity

A systematic scoping review on patients’ perceptions of dignity

There Is a Third Condition Aside from Survival and Death that Affects Outcome Statistics: Terminal Discharge

Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review

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