Journal of palliative medicine
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The successful practice of hospice and palliative medicine requires basic knowledge of its medicolegal aspects. In this paper, we review several recent legal cases that highlight important, evolving legal issues in palliative medicine. These issues include efforts to change to advance directive laws after the Schiavo conflict, the Attorney General's challenge to Oregon's physician-assisted dying law, and the emergence of a tort for inadequate pain management. Despite conflicting attitudes about key issues in end-of-life care, the courts' decisions in these cases have consistently advanced the interests of hospice and palliative care practitioners.
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There is an acknowledged difficulty in distinguishing between some morally and legally accepted acts that hasten dying, such as refusing life-sustaining treatment, and other acts that also hasten dying that are labeled as acts of "suicide." Recent empirical findings suggest that most terminally ill and suffering patients who voluntarily chose to stop eating and drinking as a means to hasten their dying generally experienced a "good" death. This paper explores the moral and legal status of a decision to stop eating and drinking as a means to hasten dying that is voluntarily chosen by a competent, terminally ill and suffering patient. The option of voluntarily forgoing food and fluid will be compared to other end-of-life clinical practices known to hasten dying, with emphasis on the issue of whether such practices can or should be distinguished from suicide.
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Comparative Study
Differences in hospice care between home and institutional settings.
To compare hospice care delivered at home with hospice care delivered in institutional settings, such as the nursing home. ⋯ These national data point to significant differences across hospice settings and a growing need to analyze their implications. Yet, these data also leave many questions about hospice use across settings unanswered, including whether agency costs differ in institutional compared to home settings. As policymakers seek to assess the quality and appropriateness of hospice utilization and the methods used for its payment, further empirical work is needed, including how the growing use of hospice outside the home affects options for reform.
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Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA). ⋯ As a recognized leader in end-of-life care, the VHA can play a unique role in the development of specific interventions that address the diverse needs of persons with different dying trajectories identified through this research.
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To assess the proportion of in-hospital versus in-nursing home deaths among a population of decedent nursing home residents in British Columbia, Canada, and to identify facility and individual characteristics associated with in-hospital death. ⋯ While individual characteristics play a significant role in explaining variation in site of death, residence in a NP single-site and smaller-sized facility was also associated with a greater frequency of in-hospital death.