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Melton Fitch posted an update 1 year, 6 months ago
If a woman is to undergo treatment after a diagnosis of asymptomatic disease-without symptoms being present in her lifeworld-she has to cognitively understand the severity of the disease, and assume that she would die without treatment. The absence of bodily experiences of symptoms is irrelevant it is the provision of information through which illness can manifest. The shock of diagnosis, as so often illustrated in cancer narratives, is therefore necessary in order to transform disease into an illness trajectory associated with biomedical treatment. The particular illness experiencehas profound and long-lasting consequences for a woman’s life. Understanding the suffering associated with such disease conceptions as a necessary part of the illness experience could help us to improve health care services for those afflicted.Working with cancer patients is a highly demanding task. Both, caring for physical, social and spiritual needs of cancer patients as well as an overwhelming bureaucratisation, and technologisation challenge oncologists in a way that may cause mental and physical exhaustion, often-paradoxically-despite high job and specialty satisfaction. This article (i) summarises research findings with a special focus on oncologists’ burnout (including factors associated with the phenomffenon), job satisfaction and physical health; (ii) describes potential consequences of burnout and distress, e.g., shortcomings in the physician-patient interaction in oncological treatment settings, financial implications on the health-care system, etc.; and (iii) reviews published data for interventions that may prevent or alleviate oncologists’ burnout on an organisational and/or individual level.There are undoubtedly sick people who suffer terribly, and of course this should not be. No patient with incurable cancer is to be so tortured for months or years that they want only to die and lack the means to do so. Being unable to die can be worse than death, one might say or think. But until we ourselves have crossed that frontier, we do not know this for certain. To die could be worse than not being able to die. One case is difficult to distinguish from the other. But we pretend we can distinguish them if we praise assisted suicide and euthanasia as solutions to a problem that we not only do not solve, but make worse. Do we need assisted suicide in the face of non-dying skills? The author’s answer is no we do not need euthanasia, neither in that nor in any other case. The logic of euthanasia itself decrees that it cannot be restricted to exceptional cases, based as it is on the idea that the patient’s autonomy is to be valued more highly than their actual illness. But if autonomy were of absolute value, it could not be limited to cases of severe disease. The reasons which supporters of euthanasia cite for limiting assisted suicide to the most serious cases of illness, therefore, speak against euthanasia in general. Once the first step has been taken, the application can no longer be limited if, on the one hand, the ‘autonomous’ desire for death is superior to any counter-argument, and on the other hand, no state of illness is conceivable that could call into question the alleged autonomy.Patients can determine in advance how they want to be treated in a certain situation, and in particular, situations in which they reject treatment. The provisions to be observed for the preparation and practical implementation of a living will under German law are presented and discussed. The chapter also describes the principles according to which a decision is to be made if no living will has been drafted. Additionally, it is recommended that a trusted person should be granted power of attorney, since the future course of an illness (including cancer) cannot be predicted in every detail.Terminal chaperonage embedded in palliative care deeply resonates with human needs and has undergone significant advances in the past decades. At the same time, it is in jeopardy due to austerity measures in healthcare. Its comprehensive translation in philanthropic end-of-life practice necessitates reflection on underlying ethical issues. This chapter addresses ethical aspects arising in pain and terminal chaperonage and deduces important ethical imperatives in the wake of the palliative mandate. The imperatives affect the deployment of resources necessary for a humane pain and terminal chaperonage, one that is to be comprehensive and flexible in design and implementation at the same time. Furthermore, they are concerned with critical implications for dying clients emerging from the idiosyncratic properties of opioids with respect to their potential to induce mental status alterations. selleck chemicals Given that living and dying are profoundly mental by nature, the human mind plays a fundamental role in the command of both. Based on this, this chapter also outlines the essentials of terminal thought plasticity and affect catharsis en route to a mindful, decent death. It identifies and advocates eight most fundamental affective, respectively cognitive fields of the human mind, the “Ensemble of the essential eight iridescent fields of relinquishment”, whose adaptable, culturally sensitive facilitation in mental management prior to death may have to be considered the core ethical imperative in terminal chaperonage – in true congruence with philanthropic end-of-life care.The care of pediatric cancer patients is a vast departure from cancer care of adults. While the available treatment modalities-chemotherapy, radiation, and surgery-are the same, the diseases, care-delivery, and outcomes differ greatly. And just as ‘children are not just little adults,’ pediatric bioethics occupies a distinct place within the broader field of bioethics. In this chapter, we will begin with an introduction to fundamental principles and frameworks for understanding ethical issues in pediatrics, highlighting the triadic nature of medical decision-making between a physician, the child-patient, and the child’s parent as the surrogate decision-maker. We will then delve into further details of how these principles and frameworks shape the care of children with cancer, examining specific ethical challenges commonly encountered by pediatric oncologists. We will traverse this landscape by examining issues involving (a) informed consent; (b) research involving children; (c) end of life; (d) genetic and genomic testing; and (e) professionalism.
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