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PubMed1996

Euthanasia and related ethical issues in dementias of later life with special reference to Alzheimer's disease.

Increased public interest and concern regarding euthanasia have been aroused in recent years by a number of developments. A succession of judgments pronounced by Courts of Law in different parts of the world have, in recent years, sanctioned the withdrawal of life sustaining procedures in cases of prolonged and irreversible unconsciousness and in patients suffering from painful and distressing terminal diseases. They have, therefore, pronounced euthanasia in these circumstances to be legally and ethically justified. This has generated wide ranging debate regarding the ethics of management of those judged beyond hope of recovery or improvement and near the terminal phase of their lives. The practice of euthanasia in The Netherlands, which has been in progress for a number of years, has also served to focus the attention of the medical and legal professions, and the public at large, upon the ethical, legal and clinical aspects of euthanasia. In the majority of patients, life had been terminated on request. But in a substantial minority, it had been undertaken on an involuntary basis. The scale of the practice of euthanasia in The Netherlands in recent years has yielded a vast body of information regarding the moral and practical dilemmas posed for doctors, families and society concerning patients who are chronically unconscious and ambiguously poised between life and death. As a high proportion of those whose lives were terminated were of advanced age, the lessons learned are closely relevant for the specific theme of this paper.

Aged↗
PubMedDate not supplied

Clinical caveats on medical assessment and treatment of pain after TBI.

The diagnosis and management of pain in the patient with traumatic brain injury (TBI) can be difficult in light of the limitations imposed by the cognitive, language, and behavioral deficits. With patients in the acute rehabilitation setting, one must be vigilant for the often subtle signs and symptoms of pain. Causes more commonly seen in the population with TBI as a consequence of the injury itself include dysautonomia, neuropathic pain, spasticity, and heterotopic ossification. Headaches may be a consequence of TBI or associated with it for other reasons. Sources of pain associated with TBI include deep venous thrombosis and others. The reader is reminded that patients with TBI are subject to all the causes of pain that affect the general population.

Autonomic Nervous System Diseases↗
PubMed2001

Cultural differences in end-of-life care.

The exact time of death for many intensive care unit patients is increasingly preceded by an end-of-life decision. Such decisions are fraught with ethical, religious, moral, cultural, and legal difficulties. Key questions surrounding this issue include the difference between withholding and withdrawing, when to withhold/withdraw, who should be involved in the decision-making process, what are the relevant legal precedents, etc. Cultural variations in attitude to such issues are perhaps expected between continents, but key differences also exist on a more local basis, for example, among the countries of Europe. Physicians need to be aware of the potential cultural differences in the attitudes not only of their colleagues, but also of their patients and families. Open discussion of these issues and some change in our attitude toward life and death are needed to enable such patients to have a pain-free, dignified death.

Attitude to Death↗
PubMed2000

The role of arousal and "gating" systems in the neurology of impaired consciousness.

A brief taxonomy of neurologic disorders resulting in global impairments of consciousness is presented. Particular emphasis is placed on focal injuries of subcortical structures that may produce disorders that are otherwise associated to large bilateral cortical injuries. A distinction between subcortical arousal and "gating" systems is developed. Both clinical and experimental studies are reviewed in the context of these disorders and their possible underlying mechanisms.

Arousal↗