Maria Elisa Barone - Argentina - Tuesday 29 - Death Diagnosis and Organ Procurement Current concepts of

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The document discusses current concepts of death, including brain death and circulatory death. It addresses the criteria for diagnosing brain death, definitions of death and consciousness, and challenges in determining death. Specifically, it examines the criteria for assessing absence of brain function, debates around organ donation practices, and ensuring death diagnosis standards are grounded in biological understanding rather than transplantation needs.

Gesundheit & Medizin Seele & Geist

CURRENT CONCEPTS OF DEATH: BRAIN DEATH AND CIRCULATORY DEATH “ A CONTINUOUS DISCUSSION ABOUT THE DIAGNOSIS CRITERIA AND THE MEANING OF THIS DIAGNOSIS” Dra. María Elisa Barone

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Critical Synopsis in Brain Death Determination: A Case Report of Brain Death

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End of Life Care: An Ethical Overview Center for Bioethics University of Minnesota 2005 2 Introduction As medical knowledge and technology increase, so do options for healthcare. When decisions arise concerning the treatment of dying patients, these options present complex ethical dilemmas. Many are faced with decisions about the best treatment to ease a patient’s final suffering. Perhaps a decision will need to be made about whether to allow a patient’s life to end by terminating treatment altogether. These decisions—regarding their own care or the care of a dying loved one—confront people from all walks of life. Beginning with a definition of death in modern society and continuing all the way through post-death issues, End of Life Care: An Ethical Overview presents significant ethical issues related to death and dying. We focus on ethical considerations of subjects that include the benefits and drawbacks of various types of modern treatment, ending life through physician assistance or termination of treatment, options for preserving the individual autonomy of the patient, the special situation of terminally ill children, and conducting medical research. Each section includes key terminology sufficient to form a basic understanding of the issue and ethical arguments on both sides of the question. A list of further resources, as well as references throughout the paper, provide quick and easy access to further information on topics of particular interest. With advances in modern medicine, people are living longer, and the number of elderly persons is increasing. As a result, the ethical issues surrounding end of life care continue to gain importance to all members of society. End of Life Care: An Ethical Overview offers a broad introduction to a number of these issues. Both basic and comprehensive, this overview will provide a starting place for those wishing to explore the complex subject of death and dying for any of a multitude of reasons. 3 CONTENTS Introduction 2 Part I What is Death? 4 Causes of Death 5 Defining the End of Life and Declaring Death 7 Non-Heart Beating Organ Donation 10 A Good Death 12 Further Resources 13 Part II Common Approaches to End of Life Care 14 Hospice Care 15 Palliative Care 16 Further Resources 19 Part III Ethical Challenges in End of Life Care 20 Access to Care 21 Prognosis 23 Pain Management 24 Withholding and Withdrawing Medical Treatment 25 (Resuscitation, Ventilation, Nutrition and Hydration, Kidney Dialysis and Antibiotic Treatments) Medical Futility 31 ...

End of Life Care An Ethic.docx

joyjonna282

The biomedical focus on dementia brought the phenomena of what was considered a normal part of ageing into the medical and scientific field of interest (Bartlett, R and O’Connor, D. 2010). This perspective comes with a strong focus on neurodegenerative decline and deficits. Even though Alzheimer’s disease was around for more than 70 years since noted by Alois Alzheimer, it was only in the 1980’s that the “disease emerged as an illness category and policy issue” (Lyman, A. 1989). The Nun Study of David A. Snowdon, PhD, which started in 1991, brought a new perspective to the research into dementia. It was discovered during autopsies that people who have lived their lives without any signs of dementia, actually had amyloid plaques and tangles in their brains congruent to people living with dementia (Snowdon, D.A. 2003). Biomedical research is at this stage the primary focus of research into dementia, receiving most of the funding budget. According to an article in Therapy Today (July 2012) in the UK alone, £66 million will be allocated to dementia research by 2015, of which only £13 million is earmarked for social science research. In the WHO report on Dementia, Daviglus M.L. et al of the US National Institutes of Health state that “firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline of Alzheimer disease”. The importance of the research findings of the biomedical model cannot be underestimated. However, considering the facts that t this point there seems to be nothing that can prevent nor cure Dementia, I am of the opinion that more research and funding should focused on creating a life worth living for people who live with dementia.

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INTRODUCTION Depression is considered one of the most disabling diseases by year 2020, according to the World Health Organization (WHO) statements. Epidemiological evidences indicate depression as an independent psychosocial risk factor for the morbidity and mortality of heart disease around the world . Although the precise pathophysiological pathways linking these disorders remain unknown, it seems that depression plays a key role in the development of heart disease, since it contributes to the overactive of the hypothalamic-pituitary-adrenocortical axis, platelet activation, and decreased heart rate variability. In 1995, the WHO concluded the largest international multicentric survey on Psychological Problems in General Health Care (PPGHC). The PPGHC searched for the form, frequency, course and outcome of psychological problems commonly seen in primary care facilities . This research had the collaboration of 15 centers from 14 countries: Ankara (Turkey), Athens (Greece), Bangalore (India), Berlin and Mainz (Germany), Ibadan (Nigeria), Manchester (United Kingdom), Nagasaki (Japan), Paris (France), Rio de Janeiro (Brazil), Santiago del Chile (Chile), Seattle (USA), Shangai (China) and Verona (Italy) . It was a cross-sectional study of two stages: first-stage, a total of 25916 consecutive attenders were screened for psychological distress, by using the 12-item General Health Questionnaire (GHQ-12); Patients screened were sampled from the GHQ-12 score strata for the second-stage: the psychiatric interview, using the Composite International Diagnostic Interview – Primary Health Care version (CIDI-PHC). It was applied to 5447 eligible persons for psychiatric assessment of depressive disorders, anxiety disorders, somatization disorders, neurasthenia and alcohol problems, according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnostic criteria. The responders were also interviewed about the presence of seven chronic medical conditions: hypertension, diabetes, arthritis, heart disease, bronchitis/emphysema, stomach disorder and common parasitic disease. During the PPGHC project, general practitioners seeing clients at the first-stage, were inquired to answer an encounter form for each patient. It consisted of some sections: reason for contact, level of overall health, physical health status, psychological health status and treatment prescribed. In almost all centers, there was a low rate of mental disorders recognized by doctors, including depressive disorders, comparing to CIDI-PHC data findings. The relationship between depression and heart disease is well documented. Some works compare symptoms of depression with heart disease; others used a variety of scales and instruments for psychiatric morbidity measurement, to study that connection. In the present study, the standardized psychiatric diagnosis for depression, generated from the CIDI-PHC, will be compared with the self-reported diagnosis of heart disease across cultures.

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Erwin Chiquete, MD, PhD Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk. Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort. Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry. Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were associated with a reduced risk. Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin

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Religion and medicine have historically gone hand in hand, but increasingly have come into conflict in the U.S. as health care has become both more secular and more heavily regulated. Law has a dual role here, simultaneously generating conflict between religion and health care, for example through new coverage mandates or legally permissible medical interventions that violate religious norms, while also acting as a tool for religious accommodation and protection of conscience. This conference identified the various ways in which law intersects with religion and health care in the United States, examined the role of law in creating or mediating conflict between religion and health care, and explored potential legal solutions to allow religion and health care to simultaneously flourish in a culturally diverse nation.

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© 2014 Korean Oncology Nursing Society www.kons.or.kr | pISSN 2287-2434 | eISSN 2287-447X 서 론 1. 연구의 필요성 매년 암 환자 발생률과 이로 인한 사망률은 점차 증가하고 있으 며 2009년에 암으로 사망한 사람은 총 69,780명으로 전체 사망자의 28.3%에 이르고 있다.1) 하지만 새로운 의료기술 발달로 치료뿐만 아 니라 회복이 불가능한 환자의 경우에도 여러 생명유지의 장치를 통 해 생명 연장이 가능하게 되었다. 의학발달이 인간의 건강증진과 수명연장에 기여한 것은 사실이지만 증가된 평균 수명이 죽음에 대 한 인간의 모든 문제를 해결한 것은 아니다. 치료가 불가능한 말기 환자들은 질병의 예방과 치료에 최우선의 목적을 두는 현대의학에 의해 억지로 생명이 연장되는 고통을 겪게 될 수도 있으며, 이러한 현상은 환자들이 인간적 품위를 유지하고 평화로운 죽음을 맞이 하는 것을 방해할 수도 있다.2) 따라서, 임종을 앞두고 있는 암 환자 들에게 생명연장의 무의미한 치료행위가 오히려 고통 받는 기간만 증가시킬 수 있기 때문에 이러한 치료가 진정한 의미가 있는지가 논쟁의 소지가 되고 있다. 말기암 환자는 임종이 다가올수록 정신적인 스트레스가 점점 더 증가하며 말기암 환자와 가족은 죽음에 대한 두려움과 고통을 공 유함으로 인해 서로 힘든 시간을 보내게 된다.3) 결국 심정지가 발생 하는 순간에도 어떻게 대응해야 할 지 충분한 준비를 하지 못한 상 종양간호연구 제14권 제1호, 2014년 3월 Asian Oncol Nurs Vol. 14 No. 1, 32-40 http://dx.doi.org/10.5388/aon.2014.14.1.32 암 환자의 심폐소생술 금지(Do-not-resuscitate: DNR)에 대한 인식과 윤리적 태도 이주연1·최은희2·박경숙3 1중앙대학교병원 내과계중환자실, 2한국성서대학교 간호학부, 3중앙대학교 적십자간호대학 Awareness and Ethical Attitudes Toward ‘Do-Not-Resuscitate (DNR)’ for Cancer Patients Lee, Joo Yeon1 · Choi, Eun Hee2 · Park, Kyung Sook3 1Nursing Department, Chung-ang University Healthcare System, Seoul; 2Department of Nursing, Korean Bible University, Seoul; 3Department of Nursing, Chung- Ang University, Seoul, Korea Purpose: This descriptive study was conducted to investigate awareness and attitudes toward ‘Do-Not-Resuscitate (DNR)’. Methods: Study data were collected from July 24 to September 30, 2011 using structured questionnaires. Study subjects were 209 patients suffering from cancer at “C” Univ. hospital located in Seoul and Cancer Patient Coalition in Seoul. The purpose of the study was explained directly to them. All the data of 209 questionnaires were collected and analyzed without dropping out. Results: In terms of awareness toward DNR, 61.5% said DNR is “necessary” because “their recoveries are impossible” (51.7%) and “they want dignified deaths” (41.1%). When it comes to ethical attitudes toward DNR according to demographic characteristics, there were significant differences both between genders (p < .032) on “Medical staff should tell hopeless patients their conditions openly” and between level of education and monthly income (p < .013) on “DNR decision should be made according to the guideline, if needed”. Conclusion: The result of this study suggests that decisions on DNR should be made not by only families and doctors but by patients themselves as well. For this, sufficient explanations and education programs for DNR need to be developed and DNR decision including both patient’s and fami- ly’s demand should be standardized. Key Words : DNR, Cancer, Ethics, Awareness, Attitude 주요어: 심폐소생술 금지, 암 환자, 인식, 윤리적 태도 *본 논문은 제1저자 이주연의 2012년 석사학위논문의 일부를 발췌한 것임. *This article is based on a part of the first author’s master’s thesis from Chung-Ang University. Address reprint requests to: Choi, Eun Hee Department of Nursing, Korean.

© 2014 Korean Oncology Nursing Society www.kons.or.kr pISS.docx

susanschei

Concept of death, definition death, brain death, brain stem death, whole brain death, Harvard school ad hoc committee, Minnesota Criteria, Sydney declaration 1968, brainstem reflexes, pupillary reflex, corneal reflex, trauma, apnoea testing, apnea, timing, neonates death, CT angiography, organ transplantation, The transplantation of human Organs act 1994, lung transplant. cornea transplant, EEG, TCD, SSEP, Ventilator dependent patient, Large stroke, Hypoxic brain injury, Organ retrieval, India, UK, USA criteria, Cervical spine injury, Polytrauma, facial injury

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