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T Nilstun

Publications and source records attributed to T Nilstun.

At least 55 records · Page 3Linked to original sources
PubMed1997

Deciding not to resuscitate. Responsibilities of physicians and nurses--a proposal.

After discussing the decision with the staff, physicians should investigate the conditions for a do-not-resuscitate (DNR) order, make the decision, and inform the patient and the family. But, according to the present and other studies, they are not taking the full responsibility for these tasks. Nurses are supposed to participate in the discussions with the physicians prior to a DNR decision, but not to make the decision or to inform the patient and the family. Physicians and nurses have different opinions about their legitimate roles when DNR orders are initiated and made. However, 8% of the nurses in the present study state that they have made a DNR decision and 37% declare that the nurse should do so. We propose a model where the skills of the responsible physician (to make the diagnosis and prognosis) and the skills of the responsible nurse (to communicate with the patients by virtue of their close relationship) are combined. Accordingly, future guidelines should stress the joint responsibility of physicians and nurses to investigate the conditions precedent for a DNR order, to make the DNR decision, and to inform the patients and the family.

Decision Making↗
PubMed1996

Decisions to forego life-sustaining treatment and the duty of documentation.

OBJECTIVE: To study the current practice of documenting decisions to forego life-sustaining treatment in an intensive care unit (ICU), using the Swedish Medical Records Act as a frame of reference. SETTING: The ICU at Malmoe General Hospital, Sweden. MATERIALS: The medical records of the first 600 cases treated in the ICU in 1992. METHODS: Analysis of documents and informal observational procedures. RESULTS: Decisions to forego life-sustaining treatment were documented in the medical records of 34 patients, 17 of whom died in the ICU. In many cases, the treatment is specified, but often it is only rather vaguely described. The main reason for foregoing treatment is poor prognosis. There is no indication that the decisions had been discussed with the patients. In 18 of the 34 medical records, there are notes indicating that relatives were informed about the decision. Notes in most of the 34 medical records imply that joint deliberation took place between the anaesthesiologists in the ICU and the other physician(s) responsible for the treatment of the patient. CONCLUSION: The medical records give a fairly accurate picture of the frequency with which such decisions are made at this particular ICU, although the number might be somewhat underestimated. However, the content of the documentation is rather scanty and does not fully satisfy the requirements of the Swedish Medical Records Act. Further studies are needed to warrant any generalization.

Adolescent↗
PubMed1996

Age and life-sustaining treatment. Attitudes of intensive care unit professionals.

BACKGROUND: In Sweden, the official policy is that life-sustaining treatment should not be denied because of chronological age. This policy is also emphasised in a recent official report on priority setting in health care. But is this policy accepted among health care professionals? Do they consider chronological age relevant when decisions to forgo life-sustaining treatment are to be made? METHOD: Questionnaire survey to physicians, registered nurses and enrolled nurses at the Intensive Care Unit, University Hospital MAS, Malmö, Sweden. RESULTS: More than 65% of the respondents were of the opinion that chronological age per se influenced decisions about life-sustaining treatment. Fewer, a little more than 40%, answered that it would make a difference to their own judgment about life-sustaining treatment whether the patient is 25 or 75 years old. The respondents were also confronted with 10 different factors characterising patients in need of life-sustaining treatment. According to a majority, advance directive, decision-making capacity, and chronological age should be taken into consideration in these situations. CONCLUSION: The results indicate that chronological age is used as a criterion when decisions to forgo life-sustaining treatment are to be made in the ICU. Many health care professionals also believe that chronological age should be used as a criterion. This is clearly discordant with the official policy in Sweden and other countries, which is that age-based rationing is never justified.

Advance Directives↗
PubMed1995

Should health care be rationed by age?

Can rationing of health care by chronological age be justified on ethical grounds? The principles of equality, solidarity, liberty and efficiency are used as value premises in the discussion. Health care rationing by age is inconsistent with the principles of equality and liberty. But in some situations such rationing has support from the principles of solidarity and efficiency. The compromise suggested is that, as a rule, rationing by age should not be permitted, except in situations with intrinsic scarcity (as is the case with transplantation) and in situations with temporary extrinsic scarcity (as was the case with dialysis for a period of time). However, the main purpose is not to defend this position, but to identify and analyze the ethical conflicts such rationing gives rise to.

Age Factors↗
PubMed1994

The ethics of data utilisation: a comparison between epidemiology and journalism.

Legal controls over data collection in European countries have badly affected the work of epidemiologists. By contrast, journalists have been allowed far greater freedoms. The aims and tasks of both professions are in line with accepted values in our society--especially those of inquiry and the benefits of an open society. Society seems willing to accept that, in the interests of wider public good, journalism may sometimes invade individuals' privacy and do them harm, but it is not prepared to offer epidemiology an equal measure of tolerance.

Biomedical Research↗
PubMed1994

Ethics and public health promotion.

As a goal, promotion of public health is quite uncontroversial. But attempts to modify people's lifestyles and life conditions in order to realize this goal bring up a number of ethical conflicts. One such conflict concerns the balance between autonomy and paternalism in the process of changing human behaviour. In this paper a model for analysis of such conflicts is presented and applied to assess anti-smoking policies. The model consists of two dimensions: the first specifies the relevant ethical principles, the second specifies the persons involved in or affected by such policies. My conclusion is that anti-smoking policies cannot be justified by reference to the good of the person whose right to selfdetermination is limited, but only by reference to the need to protect others from that person, i.e. prevent them from being exposed to tobacco smoke.

Ethics, Medical↗