Only seven states have strong informed consent provisions ensuring the rights of nursing home residents, according to a new analysis released by the Long Term Care Community Coalition (LTCCC).
As an intern admitting emergency-room patients to a Cincinnati hospital, I saw it happen again and again: Late-stage cancer patients in the midst of medical crises would roll into our ER in need of a ventilator as expected complications mounted.
In the elderly, an enhanced support including specific geriatric assessment and management optimizes the treatment course, including preoperative optimization, prevents treatment-related complications and loss of autonomy using or not geriatrics clinic or rehabilitation units, and limits the length of hospital stay and costs.
These results suggest the SAKK C-SGA is a feasible practical tool for use in clinical practice. It demonstrated discriminative ability based on objective geriatric assessment measures, but additional investigations on use for clinical decision-making are warranted. The SAKK C-SGA also provides important usable domain information for intervention to optimize outcomes in older cancer patients.
As memory and executive cognitive abilities decline, these patients demonstrate initially subtle but increasingly salient changes in important decisional capacities such as treatment consent, research consent, and financial decision-making. These progressive decisional impairments raise critically important ethical issues concerning patients’ personal autonomy and competency, with implications for patients and families, and for physicians, scientists, bioethicists, and legal professionals.
A new, patient-centered ACP website that focuses on preparing patients for communication and decision making significantly improves engagement in the process of ACP and behavior change. A clinical trial of PREPARE is currently underway.
We propose a new framework for thinking about quality of life in this population, based on notions of observable person-centred outcomes and utility derived from processes of care.
I have defended (here, here, and here) surrogate selection as a mechanism for resolving medical futility disputes. But there are certainly limits. Two of the most obvious are these. First, a surrogate cannot consent to stopping LSMT when the patient herself specifically requested it. Second, the provider should not even be turning to a surrogate when the patient still has capacity.
Remarkably, St. Luke’s Hospital in Allentown, PA seems to have ignored both these limits.
Today, after reviewing a CT scan (and screwing my courage to the sticking-place) I went into an exam room, looked a patient in the eye and said:
“The liver lesions have started to grow again. I think we need to change your treatment.”
Conceptions of personhood are critical to the preservation of dignity and quality of life key to a good death and pivotal to the provision of patient centred care. Increasingly there is speculation that this role may be wider still. It has been posited that it is Confucian inspired conceptions of personhood replete with its `dualistic’ view of personhood that sees family members as part of the individual’s personhood that predispose to the prevailing practices of collusion and the trumping of patient autonomy. In a nation where family centric decision making still dominates end of life decision making, the need to appropriately conceptualise local conceptions of personhood are clear.