1/49. Assessment of need for a children's hospice program.Canuck Place, north america's first free-standing pediatric hospice of its kind, opened in 1995 in british columbia, canada. The province-wide program encompasses a broad spectrum of services intended to support community-based care and provide periodic, facility-based respite and palliative care to children with life-threatening, progressive illness and to their families. Loss and grief support is another integral component of the program. The concept of pediatric hospice care is founded on the premise that dying children and their families can benefit from care designed to maximize present quality of life; yet, the creation of such programs must be based on demonstrated need. One vital step in the development of the Canuck Place program was assessing the need for such a program within the province. Data from both traditional quantitative and less traditional qualitative sources were used to document and put forth an argument in support of developing a children's hospice program. The final report addressed several components that are summarized in this article for the purposes of assisting others who may wish to undertake similar projects in their own communities.- - - - - - - - - - ranking = 1keywords = illness, ill (Clic here for more details about this article) |
2/49. Death in the home: the doctor's responsibility.The role physicians assume when patients die at home is nebulous and ill defined. Beyond the traditional function of providing comfort and condolence to family members, the physician's duties are directed toward how our society deals with the bureaucratic and legal aspects of death. statistics are maintained regarding the numbers of deaths in municipalities and states and the causes of death, and those numbers are used by individuals and organizations for a multitude of legal, medical, and political purposes. The state also has an obvious interest in uncovering and prosecuting crime. The physician has a vital part to play in providing essential medical information for those record-keeping, statistical, and legal purposes. physicians need to be mindful of the important functions being served when they are asked to complete death certificates and to report cases and provide information to the medical examiner. As with many other physician activities, the information we provide about our patients' deaths serves a singular societal need; thus, we should view that function not as a burden but as a vital aspect of the enriching and enobling work that is uniquely ours.- - - - - - - - - - ranking = 0.26019337276415keywords = ill (Clic here for more details about this article) |
3/49. To die young, to die old management of terminal illness at age 20 and at age 85: case reports. Death and dying in a 20-year-old woman.An effort was made to provide emotional support during the terminal phase of leukemia in a 20-year-old woman. Notable were the patient's own ways of coping and the responses of her family and the hospital staff. She first denied and then recognized her own dying. Her anger was prominent, and she withdrew from objects toward the end. The intense stresses in the doctor-patient relationship, transference, countertransference, and reality factors are described.- - - - - - - - - - ranking = 4keywords = illness, ill (Clic here for more details about this article) |
4/49. injections and the fear of death: an essay on the limits of biomedicine among the Dagomba of northern ghana.This article offers a cultural ("indigenous") explanation of why people in their quest for therapy sometimes reject biomedicine. The argument is that in the current debate over the power of biomedicine, there is a lack of scrutiny of its "failures", i.e. of why people occasionally refuse to accept the offers of biomedicine and its most powerful therapy, injection-therapy. After introducing the problem, the relevant literature and the methods used, the article proceeds by first using historical material regarding vaccination campaigns and the treatment of endemic diseases in ghana and comparative data from elsewhere in africa to show that people may be ambivalent and have a mixed view of the power of biomedicine. In the context of their experiences, people (possibly, in particular, older ones) have come to know both the (early) failures as well as the successes of injection-therapy. Turning to the ethnographic present (1990-1997) the record of Dagomba notions of health and illness as well as two cases are analyzed to define this ambiguity also among younger members of Dagomba culture. Thus, the article oscillates between ethnography and history to define people's ambivalence and the conflict between biomedicine and local understandings.- - - - - - - - - - ranking = 1.2601933727641keywords = illness, ill (Clic here for more details about this article) |
5/49. Clinical supervision, death, Heidegger and Freud come 'out of the sighs'.In his recent paper on clinical supervision, 'Out of the sighs' - an existential-phenomenological method of clinical supervision: the contribution to palliative care', in this journal, Jones weds psychoanalytical ideas with Heidegger's existential-phenomenological concepts to provide a theoretical framework for clinical supervision in palliative nursing. Although this is an interesting undertaking, theoretical diversity is not a simple matter of merely interchanging concepts. Rather, it is a complex process that must account for varying philosophical assumptions upon which any theory attempts to explain or understand reality. This paper examines the major themes identified by Jones. In particular, it focuses on the spirit of ontological hermeneutics and psychoanalysis, represented by their respective founders, Heidegger and Freud, and in general, refers to other thinkers and ideas mentioned by Jones - as for instance, Schon's reflective practice, Polanyi's personal commitment, Husserl's lived experience, Schutz's intersubjectivity and Yalom's existential disidentification. Here, discussion concerns the subject-object polarity. The paper argues that many of these philosophies are incompatible. In particular, psychoanalysis and existentialism imply inconsistent aims in that psychology does not equate with fundamental ontology - and Jones has not adequately distinguished between these in his supervision discourse. The implications of the accompanying conceptual problems for the practice of clinical supervision in palliative nursing are exemplified by Jones's case study of Lindsey, a dying patient.- - - - - - - - - - ranking = 1.0086606186221keywords = person (Clic here for more details about this article) |
6/49. Life after death: a practical approach to grief and bereavement.This consensus paper describes the essential skills that clinicians need to help persons who are experiencing grief after the death of a loved one. Four aspects of the grieving process are reviewed: anticipatory grief, acute grief, normal grief reactions, and complicated grief. Techniques for assessment and recommendations about interventions and indications for referral are provided for each aspect.- - - - - - - - - - ranking = 1.2688539913863keywords = person, ill (Clic here for more details about this article) |
7/49. Sperm harvesting and post-mortem fatherhood.The motives and consequences of harvesting sperm from brain dead males for the purpose of effecting post mortem fatherhood are examined. I argue that sperm harvesting and post mortem fatherhood raise no harms of a magnitude that would justify forbidding the practice outright. Dead men are not obviously harmed by the practice; children need not be harmed by this kind of birth; and the practice enlarges rather than diminishes the reproductive choices of surviving partners. Certain ethical and legal issues nevertheless require attention. As a matter of consistency with other harvesting protocols, there ought to be a mechanism for respecting the wishes of men who when alive do not wish to become fathers post mortem. Mechanisms governing entitlement to harvest and use sperm will also be required. I note that the law is unlikely to recognize the paternity of children born from harvested sperm, though there may be reasons to recognize that paternity in some instances.- - - - - - - - - - ranking = 0.26019337276415keywords = ill (Clic here for more details about this article) |
8/49. To die young, to die old management of terminal illness at age 20 and at age 85: case reports. Death and dying in an 85-year-old woman.In conclusion, preparing for death is a developmental task. Whether faced with acute illness or old age, the inevitability of death comprises part of the mental life of all of us. As with all other developmental tasks, the quality of mastery depends on mastery of earlier developmental tasks and the related adaptive capacities of the ego. Mrs. F. had the good fortune of family support, concrete help in the household, and casework treatment that many of the aged do not have. However, past experiences, coupled with an ability to work out problems and to utilize available external resources, helped her to work through feelings about her own impending death.- - - - - - - - - - ranking = 5keywords = illness, ill (Clic here for more details about this article) |
9/49. adolescent grief: "It never really hit me...until it actually happened".In the united states, more than 2 million children and adolescents (3.4%) younger than 18 years have experienced the death of a parent. When death can be anticipated, as with a terminal illness, and even when the death is sudden, as in the September 11, 2001, attacks on the World Trade Center and Pentagon, physicians and other health care professionals have an opportunity to ameliorate the impact of the loss. Developmental factors shape adolescents' reactions and responses to the death of a parent. Recent research in childhood and adolescent bereavement shows how health professionals can support the adolescent's coping strategies and prepare the family to facilitate an adolescent's mastery of adaptive tasks posed by the terminal phase of the parent's illness, the death, and its aftermath. Robert, a bereaved 14-year-old, illustrates some of these adaptive challenges.- - - - - - - - - - ranking = 2.5203867455283keywords = illness, ill (Clic here for more details about this article) |
10/49. Caregiving at the end of life.Meeting the demands of chronic illness and disease states is challenging, at best. Too often, the chronicity of the illness hastens death. The physical, psychological, and sociological changes that accompany the death of an individual require attention and forethought if the life transition is to be made with elegance and grace. This article addresses the caregiving demands for the professional and familial/social support surrounding the chronically ill individual at the end of life. Focus is placed on the preparation of advance directives-legal documents that set clear boundaries for honoring the wishes of the patient.- - - - - - - - - - ranking = 2.2601933727641keywords = illness, ill (Clic here for more details about this article) |
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