J Palliat Care
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In this paper, I review Canadian law in relation to the unilateral withholding or withdrawal of potentially life-sustaining treatment, and I look at such questions as whether physicians are legally permitted to unilaterally put a do-not-resuscitate (DNR) order on a patient's chart. I explore who has the legal authority in Canada to decide on withholding and withdrawal of potentially life-sustaining treatment, and I conclude that unilateral withholding and withdrawal is a violation of the strong social commitment to dignity as it is understood and reflected in the law by the Supreme Court of Canada. I then offer a concrete proposal for institutional policy with respect to unilateral withholding and withdrawal of treatment in light of the law.
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With increasing trends towards home care of children with even the most complex conditions and care requirements, respite becomes critical in improving the quality of life for terminally ill children and their families. This article reports on the respite component of an evaluation project that examined the effect of the Canuck Place children's hospice program on the families it served during its first 30 months of operation. Canuck Place, located in Vancouver, British Columbia, Canada, is the first free-standing children's hospice in North America. ⋯ Sixty-five parents responded to the respite questions. They cited a wide range of benefits to the ill child, the child's siblings, and to the parents themselves; they also offered a few cautions. Our discussion focuses on three "lessons learned" from this unique investigation of respite within pediatric hospice care.
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One strategy for improving access to palliative care services in rural and remote communities is to educate community-based health professionals in the knowledge and skills required to provide end-of-life care. It is, therefore, important to evaluate palliative care educational initiatives. ⋯ Results confirm that the goals of the education program were met, and that rural and remote communities reported a greater capacity to deliver palliative care. Nevertheless, respondents identified a lack of resources, especially home care visits, as an obstacle to improving care.
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The basic tenets of palliative care are frequently subsumed under the goal of helping patients to die with dignity. Our research group has studied the issue of dignity, with dying patients serving as the primary informants. ⋯ Finally, we provide the rationale based on the Dignity Model for a psychotherapeutic intervention we have coined Dignity Therapy. This brief, individualized therapeutic approach has been informed by our dignity work, and specifically designed for application in patients nearing death.
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Dyspnea is a disturbing symptom frequently experienced by patients with advanced cancer. Supplemental oxygen is commonly used as palliative treatment in this setting. We undertook a telephone survey of physicians authorized to prescribe home oxygen according to eligibility criteria determined by publicly funded home care service. ⋯ There was a wide range of perceived benefits to oxygen prescription. In conclusion, physician practices for prescribing supplemental oxygen in the palliative care setting are variable. Further research is needed.