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\"This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practiced only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated, and helped regulate it. Some of them have themselves practiced euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practiced and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice\"--Provided by publisher.

The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost. We begin this paper with an overview of the concept of patient satisfaction, which remains poorly and variously defined. Next, we trace the evolution of patient‐satisfaction surveys, including both their useful and problematic aspects. We then describe the effects of these surveys, the most troubling of which may be their influence on the behavior of health professionals. The pursuit of high patient‐satisfaction scores may actually lead health professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even harmful treatments. Patient satisfaction is important, especially when it is a response to being treated with dignity and respect, and patient‐satisfaction surveys have a valuable place in evaluating health care. Nonetheless, some uses and consequences of these surveys may actively mislead health care. Our critique of patient‐satisfaction surveys takes into consideration three different ways patients may be “satisfied.” First is the provision of medically necessary care that actually improves their outcomes. The second concerns interventions that patients or families want but that are medically unnecessary and may negatively affect health outcomes. The third category—comprising factors that are less likely to affect health outcomes but may certainly contribute to a sense of dignity and well‐being—includes “humanistic” aspects of health care, such as good communication and treating patients with respect, as well as peripheral aspects, such as convenient parking and designer hospital gowns. These distinctions are important as we explore patient satisfaction and its implications.

In 1989, Susan Wolf convincingly warned of a troublesome consequence that should discourage any movement in American society towards physician-assisted death—a legal backlash against the gains made for limiting life-sustaining treatment. The authors demonstrate that this dire consequence did not come to pass. As physician-assisted suicide gains a foothold in USA and elsewhere, many other slippery slope arguments are being put forward. Although many of these speculations should be taken seriously, they do not justify halting the new practice. Instead, our courts, regulatory agencies, journalists, professional organisations and researchers should carefully monitor and study it as it unfolds, allowing continuous improvement just as our society has done in implementing the practice of limiting life-sustaining treatment.

Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much more likely to influence a decision to pursue or reject aggressive life‐extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor—particularly in the context of an inadequate social safety net—robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision‐making, the irrational distinction between PAD and withdrawal of life‐sustaining care, and the more appropriate focus on the great flaws in the American health care system.

Just like people from a tropical climate who have migrated to the arctic, notes Shewmon, we have recently migrated into a world in which medical technology allows us to stretch out a dying process that used to take place all at once. Because the simple concept and word for 'death' are outdated, terms such as 'biologically dead', 'clinically dead', 'irreversibly dead', 'dead because a moral choice was made not to intervene', 'legally dead', 'biographically dead' and 'socially dead' appear regularly and often interchangeably in clinical, academic and public discourse. The authors of the study from Florida State indirectly acknowledge the magnitude of the linguistic problem when they try to explain why one of their own findings seriously undermines their conclusion that abandoning the dead donor rule may not be out of touch with public opinion. 2 Taking this limitation into account, how do academics effectively educate and communicate about death with a public that seems content with the status quo?

In this paper, I will argue that in an intensive care environment, the exact moment of death is neither a scientific nor philosophical \"fact.\" Rather, it is a socially constructed notion used to maximize organ procurement while avoiding responsibility for killing patients by removing their organs-the so-called dead donor rule. I will first review the tremendous importance of the declaration of death in all societies and point out how it once was and now has again become problematic. Next, I will review the importance of distinguishing among definitions, criteria, and tests. I will conclude that the current protocols for taking organs from brain-dead patients do so by maintaining several legal and clinical fictions. They are fictions because they are conceptually and clinically suspect and have been created primarily to avoid controversy. This has allowed removal of organs that save and improve many thousands of lives. I will argue that while brain-dead patients are not certainly dead, they are certainly beyond harm. In this sense, they are as good as dead as long as they and their families have agreed to organ procurement. Whether the current fictions about brain death are durable remains to be seen.

The therapeutic promise of transplanting organs from cadaveric donors, as envisioned by the pioneers of transplantation, 1 has never been realized because the demand for cadaveric organs has far exceeded the supply. The waiting list for organ transplants continues to grow, and in 2000, nearly 5000 patients were removed from the list because of death. 2 Consequently, many patients with end-stage organ failure are no longer relying solely on the waiting list. Instead, they are turning to spouses, friends, or strangers as possible donors — a medically acceptable alternative because advances in immunosuppression have eliminated the requirement of a genetic match for . . .

Background Do-Not-Resuscitate (DNR) patients tend to receive less medical care after the order is written. To provide a clearer approach, the Ohio Department of Health adopted the Do-Not-Resuscitate law in 1998, indicating two distinct protocols of DNR orders that allow DNR patients to choose the medical care: DNR Comfort Care (DNRCC), implying DNRCC patients receive only comfort care after the order is written; and DNR Comfort Care-Arrest (DNRCC-Arrest), implying that DNRCC-Arrest patients are eligible to receive aggressive interventions until cardiac or respiratory arrest. The aim of this study was to examine the medical care provided to patients with these two distinct protocols of DNR orders. Methods Data were collected from August 2002 to December 2005 at a medical intensive care unit in a university-affiliated teaching hospital. In total, 188 DNRCC-Arrest patients, 88 DNRCC patients, and 2,051 non-DNR patients were included. Propensity score matching using multivariate logistic regression was used to balance the confounding variables between the 188 DNRCC-Arrest and 2,051 non-DNR patients, and between the 88 DNRCC and 2,051 non-DNR patients. The daily cost of intensive care unit (ICU) stay, the daily cost of hospital stay, the daily discretionary cost of ICU stay, six aggressive interventions, and three comfort care measures were used to indicate the medical care patients received. The association of each continuous variable and categorical variable with having a DNR order written was analyzed using Student's t -test and the χ 2 test, respectively. The six aggressive interventions and three comfort care measures performed before and after the order was initiated were compared using McNemar's test. Results DNRCC patients received significantly fewer aggressive interventions and more comfort care after the order was initiated. By contrast, for DNRCC-Arrest patients, the six aggressive interventions provided were not significantly decreased, but the three comfort care measures were significantly increased after the order was initiated. In addition, the three medical costs were not significantly different between DNRCC and non-DNR patients, or between DNRCC-Arrest and non-DNR patients. Conclusions When medical care provided to DNR patients is clearly indicated, healthcare professionals will provide the medical care determined by patient/surrogate decision-makers and healthcare professionals, rather than blindly decreasing medical care.

The objective of the multidisciplinary expert Consensus Panel on Research with the Recently Dead (CPRRD) was to craft ethics guidelines for research with the recently dead. The CPRRD recommends that research with the recently dead: (i) receive scientific and ethical review and oversight; (ii) involve the community of potential research subjects; (iii) be coordinated with organ procurement organizations; (iv) not conflict with organ donation or required autopsy; (v) use procedures respectful of the dead; (vi) be restricted to one procedure per day; (vii) preferably be authorized by first-person consent, though both general advance research directives and surrogate consent are acceptable; (viii) protect confidentiality; (ix) not impose costs on subjects' estates or next of kin and not involve payment; (x) clearly explain ultimate disposition of the body.