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Ethical issues in diagnosis and management of patients in the permanent vegetative state

Derick T Wade, consultant and professor in neurological disability. Rivermead Rehabilitation Centre, Oxford OX1 4XD

Summary points

  • The diagnosis of the permanent vegetative state cannot be absolutely certain
  • There is no standard test of awareness and data on prognosis are limited
  • Patients in the permanent vegetative state raise ethical issues concerning the nature of consciousness, quality of life, the value society attributes to life, and handling of uncertainty
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Position Statement on Euthanasia

The national peak body for palliative care, Palliative Care Australia, issued their most recent Statement on Euthanasia (Why not voluntary euthanasia?, one might ask.) in March 1999 at their Nation

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Are Living Wills Followed?

Having an advance directive is no guarantee that end-of-life wishes will be honored. A 1995 Robert Wood Johnson Foundation-funded study of 4,300 critically ill patients found that only 49 percent who requested do not resuscitate (DNR) orders actually got them; 70 percent of those patients were never asked their preferences. There have been many cases in which individuals who have taken all the right steps have been deprived of seeing their loved ones’ wishes carried out because of physician, family, or institutional resistance.

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ABSENCE OF URGENCY: A DEADLY PROBLEM WHEN STROKES OCCUR

NEW YORK TIMES Health Section

By Laurie Tarkin, Jenny Warburg for The New York Times

Of the estimated 730,000 Americans who have strokes each year, nearly 160,000 die and another 400,000 suffer varying degrees of disability. Yet, when stroke patients arrive at emergency rooms, medical experts say, they are not usually treated with the urgency required.

The less-than-rapid response, in some cases, can make the difference between full recovery and permanent debilitating disease or death.

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CHOICES: SOUNDS OF SILENCE ON MATTERS OF HOSPICE

NEW YORK TIMES, Health Section (Tues, February 13, 2001)

By Eric Nagourney

Despite recent growth of the hospice field, intended to help the terminally ill die as peacefully as possible, most Americans still die in hospitals. Other studies had found that doctors often failed to tell patients’ families about their options; now, a new report suggests that nurses, too, may play a role.

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ATTITUDES AND DESIRES RELATED TO EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE AMONG TERMINALLY ILL PATIENTS AND THEIR CAREGIVERS

Journal of the American Medical Association (JAMA), Nov. 16, 2000, Vol;284:2460-2468

This article received considerable attention in the press when it was released.

Author Information Ezekiel J. Emanuel, MD, PhD; Diane L. Fairclough, DPH; Linda L. Emanuel, MD, PhD

Context Euthanasia and physician-assisted suicide (PAS) are highly controversial issues. While there are studies of seriously ill patients’ interest in euthanasia and PAS, there are no data on the attitudes and desires of terminally ill patients regarding these issues.

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