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Document1Fromme,ErikKZive,DanaSchmidt,TerriAOlszewski,ElizabethTolle,SusanWPOLSTRegistrydonotresuscitateordersandotherpatienttreatmentpreferences.JAMA:thejournaloftheAmericanMedicalAssociation2012Jan4307(1):345

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* Document2Jackson,EmilyandKeown,JohnDEBATINGEUTHANASIAOxford/Portland,OR:HartPublishing,2012.190p.Callnumber:K3611.E95J332012

Document3Jones,DavidAlbert"Istherealogicalslipperyslopefromvoluntarytononvoluntaryeuthanasia?"KennedyInstituteofEthicsJournal2011December21(4):379404


Document4Tierney,WilliamMChris'tears.Annalsofinternalmedicine2011Nov1155(9):644


Document5Lantos,JohnDMeadow,WilliamLShouldthe"slowcode"beresuscitated?TheAmericanjournalofbioethics:AJOB2011Nov11(11):812Abstract:Mostbioethicistsandprofessionalmedicalsocietiescondemnthepracticeof"slowcodes."TheAmericanCollegeofPhysiciansethicsmanualstates,"Becauseitisdeceptive,physiciansornursesshouldnotperformhalfheartedresuscitationefforts('slowcodes')."Aleadingtextbookcallsslowcodes"dishonest,crassdissimulation,andunethical."Amedicalsociologistdescribesthemas"deplorable,dishonestandinconsistentwithestablishedethicalprinciples."Nevertheless,webelievethatslowcodesmaybeappropriateandethicallydefensibleinsituationsinwhichcardiopulmonaryresuscitation(CPR)islikelytobeineffective,thefamilydecisionmakers

http://bioethics.georgetown.edu/databases/http://www11.georgetown.edu/research/nrcbl/databases/EthxWeb/ethxbool.htmhttp://kie.georgetown.edu/netacgi/nph-brs?co1=AND&co2=AND&co3=AND&co4=AND&d=EWEB&Sect2=THESON&u=http%3A%2F%2Fwww11.georgetown.edu%2Fresearch%2Fnrcbl%2Fdatabases%2FEthxWeb%2Fethxbool.htm&r=0&p=2&f=S&l=50&s4=20.5.1.pc.+not+(news+or+editorial+or+letter+)%0D%0A+and+%40yd+%3E%3D20050000&s2=&co5=AND&pg1=SUBJ&op1=AND&s1=&co6=AND&op6=AND&s6=&Sect3=PLURON&Sect5=HITOFF&l=0http://kie.georgetown.edu/netacgi/nph-brs?co1=AND&co2=AND&co3=AND&co4=AND&d=EWEB&Sect2=THESON&u=http%3A%2F%2Fwww11.georgetown.edu%2Fresearch%2Fnrcbl%2Fdatabases%2FEthxWeb%2Fethxbool.htm&r=0&p=1&f=1&l=50&s4=20.5.1.pc.+not+(news+or+editorial+or+letter+)%0D%0A+and+%40yd+%3E%3D20050000&s2=&co5=AND&pg1=SUBJ&op1=AND&s1=&co6=AND&op6=AND&s6=&Sect3=PLURON&Sect5=HITOFF&l=0http://ethicslab.org/openurl/wc/0000341218/http://ethicslab.org/openurl/gt/0000341218/http://catalog.library.georgetown.edu/search/c?SEARCH=K3611%20.E95%20J33%202012&sortdropdown=-&searchscope=4http://ethicslab.org/openurl/wc/0000341202/http://ethicslab.org/openurl/wc/0000341150/http://ethicslab.org/openurl/gt/0000341150/http://ethicslab.org/openurl/wc/0000341093/http://ethicslab.org/openurl/gt/0000341093/

understandandacceptthatdeathisinevitable,andthosefamilymemberscannotbringthemselvestoconsentorevenassenttoadonotresuscitate(DNR)order.Insuchcases,weargue,physiciansmaybestserveboththepatientandthefamilybyhavingacarefullyambiguousdiscussionaboutendoflifeoptionsandthenprovidingresuscitationeffortsthatarelessvigorousorprolongedthanusual.


Document6Paris,JohnJMoore,MichaelPatrickTheresuscitationof"slowcodes":fraud,lies,anddeception.TheAmericanjournalofbioethics:AJOB2011Nov11(11):134


Document7Morrison,WynneFeudtner,ChrisQuickandlimitedisbetterthanslow,sloppy,orsly.TheAmericanjournalofbioethics:AJOB2011Nov11(11):156


Document8Mercurio,MarkRFakingit:unnecessarydeceptionsandtheslowcode.TheAmericanjournalofbioethics:AJOB2011Nov11(11):178


Document9Janvier,AnnieBarrington,KeithWhatisan"appropriatecode"?TheAmericanjournalofbioethics:AJOB2011Nov11(11):1820


Document10Berger,JeffreyTMisadventuresinCPR:neglectingnonmaleficentandadvocacyobligations.TheAmericanjournalofbioethics:AJOB2011Nov11(11):201


Document11Kon,AlexanderAInformednondissent:abetteroptionthanslowcodeswhenfamiliescannotbeartosay"letherdie".TheAmericanjournalofbioethics:AJOB2011Nov11(11):223

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Document12Allen,WilliamLawrenceLet'sDoNotResuscitatePlaceboCardiopulmonaryResuscitation.TheAmericanjournalofbioethics:AJOB2011Nov11(11):245


Document13Clark,JonnaDDudzinski,DeniseMThefalsedichotomy:do"everything"orgiveup.TheAmericanjournalofbioethics:AJOB2011Nov11(11):267


Document14Weinacker,AnnThe"slowcode"shouldbea"nocode".TheAmericanjournalofbioethics:AJOB2011Nov11(11):279


Document15Ladd,RosalindEkmanForman,EdwinNWhynotatransparentslowcode?TheAmericanjournalofbioethics:AJOB2011Nov11(11):2930


Document16Hickman,SusanENelson,ChristineAMoss,AlvinHTolle,SusanWPerrin,NancyAHammes,BernardJTheconsistencybetweentreatmentsprovidedtonursingfacilityresidentsandordersonthephysicianordersforlifesustainingtreatmentform.JournaloftheAmericanGeriatricsSociety2011Nov59(11):20919Abstract:ToevaluatetheconsistencybetweentreatmentsprovidedandPhysicianOrdersforLifeSustainingTreatment(POLST)orders.


Document17Jox,RalfJKhlmeyer,KatjaBorasio,GianDomenico[VegetativestatepatientRomHouben:certainlydidnotwakeup].=WachkomaPatientRomHouben:Sichernichtaufgewacht.MMWFortschrittederMedizin2011Oct20153(42):24



Document18Mishra,PrasannaKEuthanasia:ethicalrisks.Indianjournalofmedicalethics2011OctDec8(4):2612


Document19Franklin,GlenACannon,RobertWSmith,JasonWHarbrecht,BrainGMiller,FrankBRichardson,JDavidImpactofwithdrawalofcareandfutilecareontraumamortality.Surgery2011Oct150(4):85460Abstract:Theobservedtoexpected(O:E)mortalitybasedonInjurySeverityScores(ISS)hasbeenusedtoassessqualityoftraumacenter(TC)care.Injuriesintheelderlyhaveincreased,andthesepatientsoftenhaveadvanceddirectives,onoccasionlimitingaggressivecareevenforpotentiallysurvivableinjuriesunfortunately,therearefewdataontheimpactofthesedemographicchangesonmortality.Additionally,manypatientsarrivemoribundandcareprovidedislikelytobefutile.WesoughttoexaminetheimpactofthesesituationsonTCmortality.


Document20Mollberg,NathanMWise,StephenRBerman,KevinChowdhry,SaeedHolevar,MichelleSullivan,RyanVafa,AmirTheconsequencesofnoncompliancewithguidelinesforwithholdingorterminatingresuscitationintraumaticcardiacarrestpatients.TheJournaloftrauma2011Oct71(4):9971002Abstract:Thevalidityofcurrentguidelinesregardingresuscitationofpatientsintraumaticcardiopulmonaryarrest(TCPA)andtheabilityofemergencymedicalservices(EMS)toappropriatelyapplythemhavebeencalledintoquestion.ThepurposeofthisstudyistodemonstratetheconsequencesofviolatingthecurrentpublishedguidelinesandwhetherEMSpersonnelwereabletoaccuratelyidentifypatientsinTCPA.


Document21Bell,DavidCrawford,Vivienne"Murderormercy?"AninnovativemodulehelpingUKmedicalstudentstoarticulatetheirownethicalviewpointsregardingendoflifedecisions.Southernmedicaljournal2011Oct104(10):67681Abstract:ThismodulewasdesignedtoequipUKmedicalstudentstorespondethicallyandsensitivelytorequestsencounteredasqualifieddoctorsregardingeuthanasiaandassisteddying.Theaimwastoexposestudentstorelevantopinionsandexperiencesandprovideopportunitiestoexploreandjustifytheirownviewsandrehearseethicaldecisionmakinginasafelearningenvironment.Themoduleisdeliveredbyamultidisciplinaryteam,providingstudentswiththeworkingknowledgetoactivelydiscusscases,articulatetheirownviewsandpracticeethicalreasoning.Visitstointensivecareunits,palliativecarewardsandhospicesareintegratedwiththeory.Studentassessmentcomprisesadissertation,debateandreflection.Moduleimpactwasevaluatedbyanalysisofstudentcourseworkandaquestionnaire.Studentsgreatlyappreciatedtheclinicalcontextprovidedbythevisitsandopportunitiestoapplyethicalreasoningtocasesanddebateissueswithpeers.Theyreportedincreaseddiscernmentoftheethicalandlegalpositionandpracticalconsiderationsandgreaterawarenessoftherangeofprofessionalandlayviewpointsheld.Manyparticipantswerelessstronglyinfavorofeuthanasiaandassisteddyingonmodule

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completionthanattheoutset,butallofthembelievedtheywerebetterequippedtojustifytheirownviewpointandrespondtopatientrequests.Themultidisciplinarynatureofthiscoursehelpstopreparestudentstodealeffectivelyandsensitivelywithethicaldilemmastheywillencounterintheirmedicalcareer.Useofanintegrated,learnercenteredapproachequipsstudentstoactivelyengagewiththeirpeersindiscussionofsuchissuesandtoformulateanddefendtheirownposition.


Document22Hardt,JohnCommentaryon"murderormercy?".Southernmedicaljournal2011Oct104(10):6823


Document23Russo,JamesEOriginalresearch:deactivationofICDsattheendoflife:asystematicreviewofclinicalpracticesandproviderandpatientattitudes.TheAmericanjournalofnursing2011Oct111(10):2635Abstract:Theimplantablecardioverterdefibrillator(ICD)hasbecomeastandardtreatmentforpeopleatriskforlifethreateningcardiacarrhythmias.Torestorenormalheartrhythm,theICDdeliversahighenergy,painfulelectricalshock.Becausethedeviceissoeffectiveintreatingsuddencardiacarrest,peoplewithICDsaremorelikelytodiefromothercauses.ButtheirdeathscanbeneedlesslypainfuliftheICDdeliversshocksduringtheactivephaseofdying.Althoughdevicedeactivationisanoption,noformalpracticeprotocolsaddressthis,andadvanceplanningdiscussionsdon'toftenincludepotentialICDdeactivation.


Document24Grubb,BlairPKarabin,BeverlyEthicaldilemmasandendoflifechoicesforpatientswithimplantablecardiacdevices:decisionsregardingdiscontinuationoftherapy.Currenttreatmentoptionsincardiovascularmedicine2011Oct13(5):38592Abstract:OPINIONSTATEMENT:Itisourbeliefthatawelldesignedcardiacdevicemanagementprogramshouldincludeendoflifepatientandfamilyplanning,addressingpotentialdecisionsregardingwithdrawalofpacemakerand/orimplantablecardioverterdefibrillatortherapy.Guidedbythebasicethicalandlegalprinciplesoutlinedinthearticle,itistheresponsibilityoftheelectrophysiologistandotherinvolvedhealthcareproviderstointroducethistopictopatients,provideguidanceandresourcesfordecisionmaking,andhonorbothpatientandfamilyrequests.


Document25Benatar,DAlegalrighttodie:respondingtoslipperyslopeandabusearguments.Currentoncology(Toronto,Ont.)2011Oct18(5):2067


http://ethicslab.org/openurl/wc/0000340810/http://ethicslab.org/openurl/gt/0000340810/http://ethicslab.org/openurl/wc/0000340809/http://ethicslab.org/openurl/gt/0000340809/http://ethicslab.org/openurl/wc/0000340789/http://ethicslab.org/openurl/gt/0000340789/http://ethicslab.org/openurl/wc/0000340785/http://ethicslab.org/openurl/gt/0000340785/http://ethicslab.org/openurl/wc/0000340784/http://ethicslab.org/openurl/gt/0000340784/

Document26Dyer,ClareJudgerulesthatwomaninminimallyawarestateshouldnotbeallowedtodie.BMJ(Clinicalresearched.)2011September29343:d6300


Document27Borasio,GianDomenico[Endoflifedecisions:thegeneralpractitionerplaysadecisiverole].=EntscheidungenamLebensende.DerHausarztspielteinezentraleRolle.MMWFortschrittederMedizin2011Sep15153(37):28


Document28Jox,RalfJKhlmeyer,KatjaBorasio,GianDomenico[Howistheautonomyofthepatientbestprotected?Endoflifedecisionsforpatientswithdementiaandthevegetativestate].=WiewirddieAutonomiedesPatientenambestengewahrt?LetzteEntscheidungenbeiDemenzundWachkoma.MMWFortschrittederMedizin2011Sep15153(37):312,34


Document29GarcaRada,AserFamilyberatesdoctorforrefusingtofollowlawandremovefeedingtubefromwomaninacoma.BMJ(Clinicalresearched.)2011September15343:d5868


Document30Sheldon,TonyDutchdoctorscomplainaboutlongwaitforjudgmentsincasesofeuthanasia.BMJ(Clinicalresearched.)2011September12343:d5768


Document31Billings,JAndrewTheendoflifefamilymeetinginintensivecarepartII:Familycentereddecisionmaking.Journalofpalliativemedicine2011Sep14(9):10517



Document32Pope,ThaddeusMasonLegalbriefing:futileornonbeneficialtreatment.TheJournalofclinicalethics2011Fall22(3):27796Abstract:Thisissue's"LegalBriefing"columncoversrecentlegaldevelopmentsinvolvingfutileornonbeneficialmedicaltreatment.ThistopichasbeenthesubjectofrecentarticlesinJCE.Indeed,itwasthesubjectofa"LegalBriefing"infall2009.Accordingly,thiscolumnfocusesonlegaldevelopmentsfromthepasttwoyears.Thesedevelopmentsareusefullygroupedintothefollowing11categories:1.TexasAdvanceDirectivesAct,2.OntarioConsentandCapacityBoard,3.Surrogateselection,4.Expostcasesfordamages,5.Exantecasesforinjunctions,6.Coercionandduress,7.Assentandtransparency,8.Braindeathcases,9.Criminalandadministrativesanctions,10.Conscientiousobjection,11.Penaltiesforprovidingfutiletreatment.


Document33Gristina,GRDeGaudio,RMazzon,DCurtis,JREndoflifecareinItalianintensivecareunits:wherearewenow?Minervaanestesiologica2011Sep77(9):91120Abstract:MostpatientsintheICUareunabletomakedecisionsforthemselvesattheendoflife(EOL),andtheresponsibilityforthesedecisionsfallstothemedicalstaffandpatients'relatives.Therefore,cliniciansmustfrequentlycommunicatewithpatients'relativestounderstandthepatients'valuesandpreferencesastheyperformmedicaldecisionmaking.Thefamily'sroleinthisprocessvaries:theentireburdenofdecisionmakingcouldrestwiththefamily,orfamilymemberscouldbeinformedofthedecisionswithoutadmissionintothedecisionmakingprocess.Incontrasttothesetwoextremes,cliniciansandfamilymembersmayalsoenterintoshareddecisionmaking:anexchangeofviewsandopinionsbetweencliniciansandthepatient'sfamilytoenablethetwopartiestoreachdecisionstogether.Inthislatterscenario,theeffectivenessofthediscussionsthattakeplacebetweencliniciansandfamilymembersbecomesacrucialmarkerofhighqualityintensivecare.Inthisreview,weprovideanoverviewofthecurrentliteratureconcerningthestateofEOLcareinEuropeanandItalianICUsandthensummarizeseveralEuropeanandAmericanrecommendationsforimprovingEOLcareintheICU.Finally,weexaminetheopportunitytouseshareddecisionmakingtoimproveEOLcareintheICUthroughinterdisciplinarycommunication,openandrealisticdiscussionofprognosiswithfamilies,andanapproachrespectingdifferentculturalperspectives.


Document34Verniolle,MBrunel,EOlivier,MSerres,IMari,AGonzalez,HBenhaoua,HCougot,PMinville,V[Assessmentofstepstolimitandwithholdlifesupportandwithdrawlifesupportinavitalemergencydepartment].=valuationdesdmarchesdelimitationetd'arrtdetraitementensalled'accueildesurgencesvitales.Annalesfranaisesd'anesthsieetderanimation2011Sep30(9):6259Abstract:ToevaluatethepracticesofwithholdingandwithdrawingoflifesustainingtherapiesinavitalemergenciesdepartmentandtoconfrontthemwithLeonettilawprocedures.


Document35Raijmakers,NatasjaJHFradsham,SarahvanZuylen,LiaMayland,CatrionaEllershaw,JohnEvanderHeide,AgnesOPCARE9Variationinattitudestowardsartificialhydrationattheendoflife:asystematicliteraturereview.Currentopinioninsupportiveandpalliativecare2011Sep5(3):26572

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Abstract:Artificialhydrationinendoflifecareisanimportantandemotivetopicthatfrequentlyraisesconcernsfrompatients,relativesandhealthcareprofessionals(HCPs).Theaimofthisreviewwastogiveanoverviewofcurrentlyavailableevidencearoundopinionsandattitudestowardsartificialhydrationattheendoflife.


Document36Heinemeyer,Christian[Ofliferesponsibilityandillusionaryselfdetermination].=VonLebenspflichtundillusionrerSelbstbestimmung.PflegeZeitschrift2011Sep64(9):513


Document37Bauer,AxelW[Palliativemedicineandpalliativenursing:betweennursingcareandterminalcare."Certifieddying"isnotavailable].=PalliativmedizinundPalliativpflege:ZwischenFrsorgeundSterbehilfe."ZertifiziertesSterben"gibtesnicht.PflegeZeitschrift2011Sep64(9):51822


Document38Kress,Hartmut[Ethicaluncertaintyabouttheendoflife.Thereisnoobligationtolive].=EthischerZweifelangesichtsdesLebensendes.EsgibtkeineLebenspflicht.PflegeZeitschrift2011Sep64(9):5247


Document39Ruijs,CeesDMKerkhof,AJFMvanderWal,GOnwuteakaPhilipsen,BDDepressionandexplicitrequestsforeuthanasiainendoflifecancerpatientsinprimarycareintheNetherlands:alongitudinal,prospectivestudy.Familypractice2011Aug28(4):3939Abstract:IntheNetherlands,many(45%)cancerpatientsdieathome,inthecareofGPs.About1outof10endoflifecancerdeathsishastenedbyGPsthrougheuthanasiaorphysicianassistedsuicide.However,therelationshipbetweendepressionandrequestsforeuthanasiahasneverbeenprospectivelystudieddirectlyinprimarycare.


Document40Malia,CatherineBennett,MichaelIWhatinfluencespatients'decisionsonartificialhydrationattheendoflife?AQmethodologystudy.Journalofpainandsymptommanagement2011Aug42(2):192201Abstract:Artificialhydration(AH)isusedtopalliatepatientswithreducedfluidintakeattheendoflifebutisacontroversialpractice.Patients'involvementindecisionmakingvaries,andlittleisknownaboutpatients'


understandingofthebenefitsandburdensofAH.


Document41Kbler,AndrzejAdamik,BarbaraLipinskaGediga,MalgorzataKedziora,JaroslawStrozecki,LukaszEndoflifeattitudesofintensivecarephysiciansinPoland:resultsofanationalsurvey.Intensivecaremedicine2011Aug37(8):12906Abstract:Thisstudywasdesignedtoassesstheethicalattitudesandpracticesofintensivecarephysiciansregardinglifesustainingtreatmentinintensivecareunits(ICUs)inPoland.


Document42Solarino,BiagioBruno,FrancescoFrati,GiacomoDell'erba,AlessandroFrati,PaolaAnationalsurveyofItalianphysicians'attitudestowardsendoflifedecisionsfollowingthedeathofEluanaEnglaro:replytoM.Y.Rady.Intensivecaremedicine2011Aug37(8):13945


Document43Devalois,BernardBroucke,MarionRocher,FranceCasenaz,Virginie[Reflexionsontheemergenceoftherighttopracticelethalinjections].=Rflexionsautourdel'mergenced'undroitdepratiquerlesinjectionsltales.Revuedel'infirmire2011AugSep(173):378


Document44Saevareid,TrygveJohannesBalandin,SusanNurses'perceptionsofattemptingcardiopulmonaryresuscitationonoldestoldpatients.Journalofadvancednursing2011Aug67(8):173948Abstract:Thispaperisareportofastudytoexplorenurses'thoughtsandattitudesaboutcardiopulmonaryresuscitationofoldestoldpatients.


Document45Kazaure,HadizaRoman,SanzianaSosa,JulieAHighmortalityinsurgicalpatientswithdonotresuscitateorders:analysisof8256patients.Archivesofsurgery(Chicago,Ill.:1960)2011Aug146(8):9228Abstract:Toevaluateoutcomesofpatientswhoundergosurgerywithadonotresuscitate(DNR)order.



Document46Livingston,EdwardHDimick,JustinBInferringcausationfrommultipleregression:donotresuscitate?Archivesofsurgery(Chicago,Ill.:1960)2011Aug146(8):898


Document47Pickersgill,FrancesAdignifiedoutlookforendoflifecare.Nursingstandard(RoyalCollegeofNursing(GreatBritain):1987)2011Aug243025(51):623


Document48Winkler,EvaCHiddemann,WolfgangMarckmann,GeorgEthicalassessmentoflifeprolongingtreatment.Thelancetoncology2011Aug12(8):7202


Document49Dyer,ClarePartnerandsisteraskHighCourtforpermissiontolet"minimallyaware"womandie.BMJ(Clinicalresearched.)2011July25343:d4772


Document50Bale,PhillipWickendenHonoringpatients'wishesforlesshealthcare.Archivesofinternalmedicine2011Jul11171(13):1200


Document51Grudzen,CoritaAttheendoflife,sometimeslessismore.Archivesofinternalmedicine2011Jul11171(13):1201


Document52RudnickaDrozak,EwaAftyka,Anna


[Theethicsofresuscitation].=Eytkaresuscytacji.Anestezjologiaintensywnaterapia2011JulSep43(3):1906Abstract:Resuscitationshouldalwaysbeattemptedinapatientwhohasatleastatheoreticalchanceofsurvival.Thisassumesthattherearepatentcerebral,coronaryandpulmonaryvessels,areasonabletimefromcardiacarresthasnotbeenexceeded,andcardiacarrestdidnotoccurasaresultofaterminalconditioncausedbyanuntreatabledisease.Duringresuscitation,medicalpersonnelmayfacetwodilemmas:whentostartCPR,andwhen(andhow)tostopit.Apartfromvariousmedicalconditions,possibleoutcomeandwillofavictimhastobetakenintoconsideration.CPRisfrequentlystartedwithoutanadequateknowledgeofthepatient'smedicalstatus.Assoonasthelatterisobtained,adecisionaboutcontinuingCPRshouldbereconsidered.CPRand/orlifeprolongingtreatmentcanbestoppedinseveralsituations,i.e.lackofcardiovascularresponseorrecognitionofalifelimitingcondition.Thedecisionshouldbemadebyateamleader,actinginaccordancewithnationalorhouseguidelines.Interminalpatients,aDNRordershouldbeissuedwellinadvance,usuallybyanattendingphysician.Afterthat,thepatientshouldbeprovidedwithpalliativecare,consistingofpaintherapy,andtreatmentofdyspnoea,congestivecardiacfailure,etc.Intheirreview,theauthorsdiscussvariousmedicalandethicalaspectsofresuscitation,concludingthathospitalethicscommitteescouldbeofgreatvalueinsolvingcomplicatedquestionsrelatingtolimitationofresuscitationandlifeprolongingtreatment.


Document53Strech,DanielSchildmann,JanQualityofethicalguidelinesandethicalcontentinclinicalguidelines:theexampleofendoflifedecisionmaking.Journalofmedicalethics2011Jul37(7):3906Abstract:Whiletherearemanyguidelinesonhowtomakeethicaldecisionsattheendoflife,thereislittleevidenceregardingthequalityofthissortofethicalguidelines.


Document54Billings,JAndrewDoubleeffect:ausefulrulethatalonecannotjustifyhasteningdeath.Journalofmedicalethics2011Jul37(7):43740Abstract:Theruleofdoubleeffectisregularlyinvokedinethicaldiscussionsaboutpalliativesedation,terminalextubationandotherclinicalactsthatmaybeviewedashasteningdeathforimminentlydyingpatients.Unfortunately,theliteraturetendstoemploythisusefulprincipleinafashionsuggestingthatitoffersthefinalwordonthemoralacceptabilityofsuchmedicalprocedures.Infact,therulecannotbeappliedappropriatelywithoutinvokingmoraltheoriesthatarenotexplicitintheruleitself.Fourtenetsoftheruleeachrequiretheirownethicaljustification.Avarietyofmoraltheoriesarerelevanttomakingjudgementsinapluralisticsociety.Muchoftherichmoralconversationgermanetotherulehasbeenreflectedinargumentsaboutphysicianassistedsuicideandvoluntaryactiveeuthanasia,buttheruleitselfhaslimitedrelevancetothesedebates,andrequiresitsownmoraljustificationswhenappliedtootherpracticesthatmighthastendeath.


Document55Badger,JamesMEkmanLadd,RosalindConflictingvoices:Withholdtreatmentornotforapatientwithchronicselfdestructivebehavior?JONA'Shealthcarelaw,ethicsandregulation2011JulSep13(3):7983Abstract:Patientswithahistoryofchronicselfdestructiveandselfinjuriousbehaviorpresentmanydifficultiestohealthcareproviders.Thesepatientsoftenhaverelatedsubstanceabuseandpersonalitydisordersthatcomplicatetheirmedicalcare.Treatmentencountersinitiallymayberelatedtomedicaltreatmentofepisodicsubstanceintoxicatedstateswithorwithoutselfinflictedinjuries.Patientslatercandevelopcomorbidmedicalillnesses


associatedwithnonadherenceoftreatmentoriatrogenicconditions,bothofwhichresultincomplexendoflifecaredecisions.Institutionalfamiliarityofrepeatpatientsoftenleaveshealthcareprovidersfeelingresponsibleforthepatientdespitehavinglittleinfluenceoverthepatients'ultimatebehavioraloutcomes.Thisarticledescribesapatientwithchronicalcoholabuse,treatmentnoncompliance,severepersonalitydisorder,recurrentsuicidalideation,selfinjuriousbehavior,alcoholiccirrhosis,andsuicideattemptresultinginmultisysteminjuriesleadingtoanethicalconflictregardingendoflifecare.


Document56Buiting,HildeMWillems,DickLPasman,HRoelineWRurup,MetteLOnwuteakaPhilipsen,BregjeDPalliativetreatmentalternativesandeuthanasiaconsultations:aqualitativeinterviewstudy.Journalofpainandsymptommanagement2011Jul42(1):3243Abstract:Thereismuchdebateabouteuthanasiawithinthecontextofpalliativecare.ThesixcriteriaofcarefulpracticeforlawfuleuthanasiainTheNetherlandsaimtosafeguardtheeuthanasiapracticeagainstabuseandadisregardofpalliativetreatmentalternatives.Thosecriterianeedtobeevaluatedbythetreatingphysicianaswellasanindependenteuthanasiaconsultant.


Document57Flanagan,BrigidMPhilpott,SeanStrosberg,MartinAProtectingparticipantsofclinicaltrialsconductedintheintensivecareunit.Journalofintensivecaremedicine2011JulAug26(4):23749Abstract:Researchintheintensivecareunit(ICU)raisesanumberofscientificandethicalchallenges.Potentialparticipantsincriticalcarestudiesarelikelytobeconsideredparticularlyvulnerabletheymaylacksufficientcapacitytomakeinformeddecisionsabouttrialparticipation,theirhealthcareproxiesmaylacklegalauthoritytoenrolltheminresearchtrialsormaynotknowtheirtrueintent,andthelifethreateningnatureoftheillnessmaymakethemortheirsurrogatesmoresusceptibletotherapeuticmisconception.Becauseofthis,criticalcareinvestigatorsmustexerciseextremecautionwhendesigningandconductingstudiesintheICU.Inthisarticle,wereviewthekeyliteratureaddressingthevariousscientificandethicalissuesraisedbycriticalcareresearch,includingquestionsofequipoiseandtheselectionofcontrolgroups,informedconsent,therapeuticmisconception,conflictofinterest,andqualityimprovementprojects.Wealsodescribethecurrentstatusofkeypolicyorregulatoryinitiativesdesignedtoaddresstheseissues,particularlyinlightofrecentcontroversiesinvolvingcriticalcarestudiesliketheARDSNettrial.


Document58Krishna,LalitNasogastricfeedingattheendoflife:avirtueethicsapproach.Nursingethics2011Jul18(4):48594Abstract:TheuseofNasogastric(NG)feedingintheprovisionofartificialnutritionandhydrationattheendoflifehas,forthemostpart,beenregardedasfutilebythemedicalcommunity.Thispositionhasbeenledchieflybyprevailingmedicaldata.InSingapore,however,therehasbeenanincreaseinitsutilizationsupportedprimarilybysocial,religiousandculturalfactorsexpresslytoprolonglifeoftheterminallyillpatient.HerethisarticlewillseektoreviewtheethicalandclinicalimpactofthistreatmentandprovidesomeunderstandingforsuchdecisionsinthelightoftheDutyofPalliativeCare[DoPC].Complementedbyvirtueethicstheory,theDoPChighlightsandseekstorealizetheindividualcasespecificgoalsofcarethatmaximizecomfortandqualityoflifeofthepatientinthefaceofrapidattenuationoftreatmentoptionsandtheeminenceofthefinaloutcomebyconsideringeachofthesefactorsindividuallyinordertoprovidethebestoutcomeforthepatientandthefamily.



Document59Bremer,AndersSandman,LarsFutilecardiopulmonaryresuscitationforthebenefitofothers:anethicalanalysis.Nursingethics2011Jul18(4):495504Abstract:Ithasbeenreportedasanethicalproblemwithinprehospitalemergencycarethatambulanceprofessionalsadministerphysiologicallyfutilecardiopulmonaryresuscitation(CPR)topatientshavingsufferedcardiacarresttobenefitsignificantothers.Atthesametimeitisarguedthat,undercertaincircumstances,thisisanacceptablemoralpracticebysignallingthateverythingpossiblehasbeendone,andenablingthegriefofsignificantotherstobeproperlyaddressed.EvenmoregeneralmoralreasonshavebeenusedtomorallylegitimizetheuseoffutileCPR:Thatsignificantothersareatypeofpatientwithmedicalorcareneedsthatshouldbeaddressed,thattheinterestofsignificantothersshouldbeweighedintowhattodoandgivenanequalstandingtogetherwithpatientinterests,andthatsignificantotherscouldbebenefitedbycareprofessionalsunlessitgoesagainsttheexplicitwantsofthepatient.InthisarticleweexploretheseargumentsandarguethatthesupportforprovidingphysiologicallyfutileCPRintheprehospitalcontextfails.Instead,thestrategyofambulanceprofessionalsinthecaseofasuddendeathshouldbetofocusontherelevantcareneedsofthesignificantothersandprovidesupport,arrangeforapeacefulenvironmentandadministeracutegriefcounsellingatthescene,whichmightcallforadevelopedcompetencywithinthisfield.


Document60SmithMiller,CherieLVADdeactivation.Medsurgnursing:officialjournaloftheAcademyofMedicalSurgicalNurses2011JulAug20(4):207


Document61Pepersack,ThierryCommentonMonodetal:"Ethicalissuesinnutritionsupportofseverelydisabledelderlypersons".JPEN.Journalofparenteralandenteralnutrition2011Jul35(4):4379authorreply4402


Document62Petrucci,RalphJBenish,LynneACarrow,BarbaraLPrato,LisaHankins,ShelleyREisen,HowardJEntwistle,JohnWEthicalconsiderationsforventricularassistdevicesupport:a10pointmodel.ASAIOjournal(AmericanSocietyforArtificialInternalOrgans:1992)2011JulAug57(4):26873Abstract:Thepotentialforlongtermsupportonaventricularassistdevice(VAD)inthebridgetotransplant(BTT)anddestinationtherapy(DT)settingshascreatedunprecedentedethicalchallengesforpatientsandcaregivers.Concernsincludethepatient'sadaptationtolifeonadeviceandtheethical,clinical,andpracticalissuesassociatedwithlivingonmechanicalsupport.Onthebasisofourexperiencetreating175consecutiveVADpatients,wehavedevelopedamodeltoaddresstheethicalandpsychosocialneedsofpatientsundergoingVADimplantation.PatientpreparationforVADimplantationencompassesthreephases:1)initialinformationregardingthephysicaleventsinvolvedinimplantation,risksandbenefitsofcurrentdevicetechnology,andtheuseofVADasarescuedevice2)preimplantpreparationincludingcompletionofadvancedirectivesspecifictoBTT/DT,competencydetermination,andidentifyingapatientspokesperson,multidisciplinaryconsultants,andculturalpreferencesregardingdevicewithdrawaland3)VADspecificendoflifeissuesincludingplansfordevicereplacementandpalliativecarewithhospiceordevicewithdrawal.Thisthreephase10pointmodeladdressestheethicalandpsychosocialissuesthatshouldbediscussedwithpatientsundergoingVADsupport.



Document63Branch,WilliamTJr.InDante'sninthcircle.Patienteducationandcounseling2011Jul84(1):312


Document64Yuen,JacquelineKReid,MCarringtonFetters,MichaelDHospitaldonotresuscitateorders:whytheyhavefailedandhowtofixthem.Journalofgeneralinternalmedicine2011Jul26(7):7917Abstract:Donotresuscitate(DNR)ordershavebeeninuseinhospitalsnationwideforover20years.Nonetheless,ascurrentlyimplemented,theyfailtoadequatelyfulfilltheirtwointendedpurposestosupportpatientautonomyandtopreventnonbeneficialinterventions.Thesefailuresleadtoseriousconsequences.Patientsaredeprivedoftheopportunitytomakeinformeddecisionsregardingresuscitation,andCPRisperformedonpatientswhowouldhavewanteditwithheldorareharmedbytheprocedure.Thisarticlehighlightsthepersistentproblemswithtoday'suseofinpatientDNRorders,i.e.,DNRdiscussionsdonotoccurfrequentlyenoughandoccurtoolateinthecourseofpatients'illnessestoallowtheirparticipationinresuscitationdecisions.Furthermore,manyphysiciansfailtoprovideadequateinformationtoallowpatientsorsurrogatestomakeinformeddecisionsandinappropriatelyextrapolateDNRorderstolimitothertreatments.Becausethesefailingsareprimarilyduetosystemicfactorsthatresultindeficientphysicianbehaviors,weproposestrategiestotargetthesefactorsincludingchangingthehospitalculture,reforminghospitalpoliciesonDNRdiscussions,mandatingprovidercommunicationskillstraining,andusingfinancialincentives.ThesestrategiescouldhelpovercomeexistingbarrierstoproperDNRdiscussionsandaligntheuseofDNRordersclosertotheirintendedpurposesofsupportingpatientselfdeterminationandavoidingnonbeneficialinterventionsattheendoflife.


Document65Facciorusso,AntonioStanislao,MarioFanelli,MarioValori,VannaMValle,GuidoEthicalissuesondefibrillatordeactivationinendoflifepatients.Journalofcardiovascularmedicine(Hagerstown,Md.)2011Jul12(7):498500


Document66Barnato,AmberEMohan,DeepikaDowns,JulieBryce,CindyLAngus,DerekCArnold,RobertMArandomizedtrialoftheeffectofpatientraceonphysicians'intensivecareunitandlifesustainingtreatmentdecisionsforanacutelyunstableelderwithendstagecancer.Criticalcaremedicine2011Jul39(7):16639Abstract:Totestwhetherhospitalbasedphysiciansmadedifferentintensivecareunitandlifesustainingtreatmentdecisionsforotherwiseidenticalblackandwhitepatientswithendstagecancerandlifethreateninghypoxia.



Document67Jones,JamesWMcCullough,LaurenceBPatientoriginatedfutilityinsight:ethicalrightorethicalplight?Journalofvascularsurgery:officialpublication,theSocietyforVascularSurgery[and]InternationalSocietyforCardiovascularSurgery,NorthAmericanChapter2011Jul54(1):2379


Document68Torke,AlexiaMSachs,GregAHelft,PaulRPetronio,SandraPurnell,ChristiannaHui,SiuCallahan,ChristopherMTimingofdonotresuscitateordersforhospitalizedolderadultswhorequireasurrogatedecisionmaker.JournaloftheAmericanGeriatricsSociety2011Jul59(7):132631Abstract:Toexaminethefrequencyofsurrogatedecisionsforinhospitaldonotresuscitate(DNR)ordersandthetimingofDNRorderentryforsurrogatedecisions.


Document69Nau,JeanYves[Miscellaneousethicalissues(3)].=Miscellanesthiques(3).Revuemdicalesuisse2011Jun87(298):12845


Document70Thns,MatthiasSitte,Thomas[Attemptedhomicideorlegalterminationoftreatment?].="VersuchterTotschlag"oderlegalerBehandlungsabbruch?MMWFortschrittederMedizin2011Jun2153(22):445


Document71Teno,JoanMGozalo,PedroMitchell,SusanLBynum,JuliePWDosa,DavidMor,VincentTerminalhospitalizationsofnursinghomeresidents:doesfacilityincreasingtherateofdonotresuscitateordersreducethem?Journalofpainandsymptommanagement2011Jun41(6):10407Abstract:Terminalhospitalizationsarecostlyandoftenavoidablewithappropriateadvancecareplanning.


Document72Meeussen,KoenVandenBlock,LieveBossuyt,NathalieEchteld,MichaelBilsen,JohanDeliens,LucDealingwithrequestsforeuthanasia:interviewstudyamonggeneralpractitionersinBelgium.Journalofpainandsymptommanagement2011Jun41(6):106072


Abstract:Inmanycountries,physiciansareconfrontedwithrequestsforeuthanasia.NotwithstandingthateuthanasiaislegallypermittedinBelgium,itremainsthesubjectofintensedebate.


Document73Bevins,MichaelBTheethicsofpacemakerdeactivationinterminallyillpatients.Journalofpainandsymptommanagement2011Jun41(6):110610Abstract:AcoreprincipleofAmericanmedicalethicsholdsthataninformedandcapacitatedpatienthastherighttohavetreatmentswithdrawnorwithheld.Nevertheless,manycliniciansremainreluctanttohonorarequesttodeactivateapatient'spacemaker.Thisarticledescribesacaseinwhichapatientwasdeniedherrequestforpacemakerdeactivation.Severalreasonsforthisreluctancearediscussed,includinghistorical,practical,andethicalconsiderationsforopposingpacemakerdeactivation.Ultimately,however,fromanethicalstandpoint,pacemakerdeactivationissimilartowithdrawalofothertherapies.Fortunately,arecentexpertconsensusstatementsupportsapatient'srighttohaveherpacemakerdeactivated.Pacemakerdeactivationshouldonlybeperformedafterrobustinformedconsent,whichmustincludediscussionofrisks,benefits,andallviablealternativesbasedonthepatient'svaluesandgoals.


Document74Seay,GaryEuthanasiaandcommonsense:areplytoGarcia.TheJournalofmedicineandphilosophy2011Jun36(3):3217Abstract:J.L.A.Garciaholdsthatmydefenseofvoluntaryeuthanasiainanearlierpaperamountstoan"assaultontraditionalcommonsense"aboutwhatmedicalethicspermitsphysicianstodo,particularlyinsofarasIholdthataphysician'sdutytoabstainfromintentionallykillingisonlyadefeasibleduty,notanunconditionalone.ButIargueherethatitisGarcia'sviewsthataremoreatoddswithcommonsense,andthatvoluntaryeuthanasiaisinfactahumanealternativethatrespectspatientautonomyandisconsistentwiththemostfundamentalmoraldutiesofphysicians.Amongtheseisadutytorelievesuffering,whichcansometimesoutweighthefundamentaldutytoconservelife.


Document75Peterkov,HelenaWithdrawalandwithholdingofmedicaltreatment:Czechmedicallawatthecrossroads.Medicineandlaw2011Jun30(2):16978Abstract:Themakingofanendoflifedecisionrepresentsworldwideoneofthemostdifficultissuesthatphysicianscanbeconfrontedwithnotonlyshoulditberegardedasconsistingofmedicalandlegalaspects,butethicsandmoralvaluesarepresentaswell.Furthermore,itshallnotbesupposedthattheeconomicparameterisnegligible,unfortunatelyeventothecontrary.Thefactthatthedecisionisoftenmadebyphysiciansunderpressurecausedbyasystemoflimitedresources(andthereforeitcannotavoidbeingdistorted)mustbekeptinmind.Atanyrate,accordingtoCzechlawunderwhichneitherassistedsuicidenoreuthanasiaisallowed,thelegalityandlegitimacyofwithdrawalandwithholdingofmedicaltreatmentisbasedontheargumentofinformedconsentofthepatient,advanceddirectivesandthestandardoflegeartistreatment.Thesealsoshallbepleadedasdefencesineventualcriminalproceedings.



Document76Tack,SylvieCanhospitalsprohibiteuthanasia?AnanalysisfromaEuropeanhumanrightsperspective.Medicineandlaw2011Jun30(2):295306Abstract:Atpresent,infourEuropeancountrieseuthanasiaand/orphysicianassistedsuicide(PAS)aretoleratedunderstrictlegalconditions.However,inpracticethesepatientgroupsareoftendeprivedofthepossibilitytoundergosuchdecisions.ParticularlyCatholichealthcareinstitutionshavedevelopedpolicieswhichrestricttheinternalapplicationofthelaw.Yet,thelegitimacyofsuchpoliciesisquestionable.FromaEuropeanhumanrightsperspectiveitcanbedefendedthatthefreedomofassociationallowshospitalstodeveloppolicieselaboratingtheirethicalstancesoneuthanasiaandPAS.However,torespectthepatient'srighttoselfdeterminationtheconcernedhospitalsshouldatleastinformcurrentandfuturepatientsabouttherestrictivepolicyanddealcarefullywitheuthanasiaandPASrequests.Ifapatient'swishremainsseriouslyincompatiblewiththeethicalstancesofthehospital,atleastreasonableandattainablealternatives(suchasareferraltoatolerantregionalhospital)shouldbeoffered.


Document77Fenigsen,RichardOtherpeople'slives:reflectionsonmedicine,ethics,andeuthanasia.Parttwo:medicineversuseuthanasia.Issuesinlaw&medicine2011Summer27(1):5170


Document78Baeke,GoedeleWils,JeanPierreBroeckaert,Bert'Weare(not)themasterofourbody':elderlyJewishwomen'sattitudestowardseuthanasiaandassistedsuicide.Ethnicity&health2011Jun16(3):25978Abstract:InBelgium,dominantideologicaltraditionsChristianityandnonreligioushumanismhavethefloorindebatesoneuthanasiaandhardlyanyattentionispaidtothepracticesandattitudesofethnicandreligiousminorities,forinstance,Jews.Thisarticleaimstomeetthislacuna.


Document79Crozier,SSantoli,FOutin,HAegerter,PDucrocq,XBollaert,P[Severestroke:prognosis,intensivecareadmissionanddecisionsonwithholdingandwithdrawaloftreatment].=AVCgraves:pronostic,critresd'admissionenranimationetdcisionsdelimitationsetarrtdetraitements.Revueneurologique2011JunJul167(67):46873Abstract:Strokecanproduceirreversiblebraindamageofmassiveproportionleadingtoseveredisabilityandpoorqualityoflife.Resuscitationandmechanicalventilationofthesepatientsremaincontroversialbecauseofthehighmortalityandseveredisabilityinvolved.


Document80Downar,JamesLuk,TracySibbald,RobertWSantini,TatianaMikhael,JosephBerman,HershlHawryluck,


LauraWhydopatientsagreetoa"Donotresuscitate"or"Fullcode"order?Perspectivesofmedicalinpatients.Journalofgeneralinternalmedicine2011Jun26(6):5827Abstract:Themajorityofpatientswhodieinhospitalhavea"DoNotResuscitate"(DNR)orderinplaceatthetimeoftheirdeath,yetweknowverylittleaboutwhysomepatientsrequestoragreetoaDNRorder,whyothersdon't,andhowtheyviewdiscussionsofresuscitationstatus.


Document81Rich,BenAPaterniti,DeboraAConversationsabouttreatmentattheendoflife.Journalofgeneralinternalmedicine2011Jun26(6):5689


Document82Singer,PeterHownottosavealife.Bioethics2011Jun25(5):iiiii


Document83Demertzi,ALedoux,DBruno,MAVanhaudenhuyse,AGosseries,OSoddu,ASchnakers,CMoonen,GLaureys,SAttitudestowardsendoflifeissuesindisordersofconsciousness:aEuropeansurvey.Journalofneurology2011Jun258(6):105865Abstract:PreviousEuropeansurveysshowedthesupportofhealthcareprofessionalsfortreatmentwithdrawal[i.e.,artificialnutritionandhydration(ANH)inchronicvegetativestate(VS)patients].Therecentdefinitionofminimallyconsciousstate(MCS),andpossiblyresearchadvances(e.g.,functionalneuroimaging),mayhaveledtouncertaintyregardingpotentialresidualperceptionandmayhaveinfluencedopinionsofhealthcareprofessionals.TheaimofthestudywastoupdatetheendoflifeattitudestowardsVSandtodeterminetheendoflifeattitudestowardsMCS.A16itemquestionnairerelatedtoconsciousness,painandendoflifeissuesinchronic(i.e.,>1year)VSandMCSandlockedinsyndromewasdistributedamongattendantsofmedicalandscientificconferencesaroundEurope(n=59).Duringalecture,theitemswereexplainedorallytotheattendantswhoneededtoprovidewrittenyes/noresponses.Chisquaretestsandlogisticregressionanalysesidentifieddifferencesandassociationsforage,Europeanregion,religiosity,profession,andgender.WeherereportdataonitemsconcerningendoflifeissuesonchronicVSandMCS.Responseswerecollectedfrom2,475participants.ForchronicVS(>1year),66%ofhealthcareprofessionalsagreedtowithdrawtreatmentand82%wishednottobekeptalive(P1year),lessattendantsagreedtowithdrawtreatment(28%,P

Document84McGee,AndrewDefendingthesanctityoflifeprinciple:areplytoJohnKeown.Journaloflawandmedicine2011Jun18(4):82034Abstract:ThisarticleisaresponsetoProfessorJohnKeown'scriticismofmyarticle"FindingaWayThroughtheEthicalandLegalMaze:WithdrawalofMedicalTreatmentandEuthanasia"(2005)13(3)MedicalLawReview357.ThearticletakesupandrespondstoanumberofcriticismsraisedbyKeowninanattempttofurtherthedebateconcerningthemoralandlegalstatusofwithdrawinglifesustainingmeasures,itsdistinctionfromeuthanasia,andtheimplicationsofthelawfulnessofwithdrawalfortheprincipleofthesanctityoflife.


Document85Baily,MaryAnnFutility,autonomy,andcostinendoflifecare.TheJournaloflaw,medicine&ethics:ajournaloftheAmericanSocietyofLaw,Medicine&Ethics2011Summer39(2):17282Abstract:Thispaperusesthecontroversyoverthedenialofcareonfutilitygroundsasawindowintothebroaderissueoftheroleofcostindecisionsabouttreatmentneartheendoflife.Thefocusisonatopicthathasnotreceivedtheattentionitdeserves:thedifferencebetweenrefusingmedicaltreatmentanddemandingit.Theauthordiscusseshealthcarereformandtheethicsofcostcontrol,arguingthatwecannotachieveuniversalaccesstoqualitycareataffordablecarewithoutbetterpublicunderstandingofthemorallegitimacyoftakingcostintoaccountinhealthcaredecisions,evendecisionsattheendoflife.


Document86Menzel,PaulTThevalueoflifeattheendoflife:acriticalassessmentofhopeandotherfactors.TheJournaloflaw,medicine&ethics:ajournaloftheAmericanSocietyofLaw,Medicine&Ethics2011Summer39(2):21523Abstract:Lowopportunitycost,weakinfluenceofqualityoflifeinthefaceofdeath,thesocialvalueoflifeextensiontoothers,shiftingpsychologicalreferencepoints,andhopehavebeenproposedasfactorstoexplainwhypeopleapparentlyperceivemarginallifeextensionattheendoflifetohavedisproportionatelygreatervaluethanitslength.Suchvaluemayhelptoexplainwhymedicalspendingtoextendlifeattheendoflifeisashighasitis,andthevariousfactorsbehindthisvaluemightprovidenormativerationaleforthatspending.Uponcriticalanalysis,however,mostofthesefactorsturnouttobequestionableorincompletelyconceivedthisincludeshope,whichisexaminedhereinspecialdetail.Thesefactorshelptoexplaincomplexityandnuanceinthenormativeissues,buttheydonotprovideadequatejustificationforspendingashighasitoftenis.Inanycase,twoadditionalfactorsmustbeaddedtothedescriptiveexplanationofhighspending,andtheythrowitsnormativejustificationintofurtherdoubt:the"insuranceeffect"andprovidercreateddemand.Overall,theperceptionofespeciallyhighvalueoflifeattheendoflifeprovidessomenormativejustificationforhighspending,butseldomstrongjustification,andnotforspendingashighasitoftenis.


Document87Shanmuganathan,NLi,JYYong,TYHakendorf,PHBenTovim,DIThompson,CHResuscitationordersandtheirrelevancetopatients'clinicalstatusandoutcomes.QJM:monthlyjournaloftheAssociationofPhysicians2011Jun104(6):4858Abstract:Documentedresuscitationordershaverelevanceinthemanagementofapulseless,unresponsivepatient.


Althoughuseful,thefrequencyoftheirdocumentationinthecasenotesofnewlyadmittedmedicalpatientsisnotwellestablished.


Document88Kaufman,SharonRFjord,LakshmiMedicare,ethics,andreflexivelongevity:governingtimeandtreatmentinanagingsociety.Medicalanthropologyquarterly2011Jun25(2):20931Abstract:TheclinicalactivitiesthatconstitutelongevitymakingintheUnitedStatesareperhapsthequintessentialexampleofadynamicmoderntemporality,characterizedbythequestforriskreduction,thepowerfulprogressnarrativesofscienceandmedicine,andthepersonalresponsibilityofcalculatingtheworthofmoretimeinrelationtomedicaloptionsandage.Thisarticleexploreshowmedicinematerializesandproblematizestimethroughadiscussionofethicalityinthiscase,theformofgovernanceinwhichscientificevidence,Medicarepolicyandclinicalknowledgeandpracticeorganizefirst,whatbecomes"thinkable"asthebestmedicine,andsecond,howthatkindofunderstandingshapesatelosofliving.UsingliverdiseaseandlivertransplantationintheUnitedStatesasmyexample,IexploretheinfluenceofMedicarecoveragedecisionsontreatments,clinicalstandards,andethicalnecessity.Reflexivelongevityarelentlessfuturethinkingaboutlifeitselfisonefeatureofthisethicality.


Document89Munro,RobertPresentattheend.Nursingstandard(RoyalCollegeofNursing(GreatBritain):1987)2011Jun222825(42):189Abstract:Havingtimetositwithadyingpatientwouldbeeverynurse'sideal,butinrealitythatisoftennotpossible.Onetrusthasfoundadifferentmethodofsupport.


Document90Hoff,LenaHermern,GranBetweenuncertaintyandcertainty.TheJournalofclinicalethics2011Summer22(2):13950Abstract:Inthisstudy,10hematologistsand10lungoncologistswereinterviewedregardingtheinformationtheyprovidetopatientsinfoursituationsofuncertainty:determiningthetreatmentthatisinthepatient'sbestinterestrecurrenceorprogressionofthepatient'sdiseasedeterminingwhentowithdrawlifeprolongingtreatmentdiscussingdeath,addressingquestionssuchaswhetherthepatientwilldiefromthedisease,andwhen.Theprimaryfindingisthatdeliveryofinformationtopatientswithlowsurvivalratescanbeimprovedbymoreandbetterdisclosurebyphysiciansatanearlierstage.Thecrucialpointforphysiciansistoascertainthewishesofpatients,tolearnwhattorevealaboutwhatpatientsshouldexpect,shorttermandlongterm,asdeathapproaches.


Document91Coulehan,JackDeephope:asongwithoutwords.Theoreticalmedicineandbioethics2011Jun32(3):14360Abstract:Hopehelpsalleviatesuffering.Inthecaseofterminalillness,recentexperienceinpalliativemedicinehastaughtphysiciansthathopeisdurableandoftenthriveseveninthefaceofimminentdeath.Inthisarticle,Iexaminetheperspectivesofphilosophers,theologians,psychologists,clinicians,neuroscientists,andpoets,andprovidea


seriesofobservations,connections,andgesturesabouthope,particularlyaboutwhatIcall"deephope."Iendwithsomeproposalsabouthowsuchhopecanbesustainedandenhancedattheendoflife.Studiesofterminallyillpatientshaverevealedclustersofpersonalandsituationalfactorsassociatedwithenhancementorsuppressionofhopeattheendoflife.Interpersonalconnectedness,attainablegoals,spiritualbeliefsandpractices,personalattributesofdetermination,courage,andserenity,lightheartedness,upliftingmemories,andaffirmationofpersonalworthenhancehope,whileuncontrollablepainanddiscomfort,abandonmentandisolation,anddevaluationofpersonhoodsuppresshope.Isuggestthatmostofthesefactorscanbemodulatedbygoodmedicalcare,utilizingbasicinterpersonaltechniquesthatdemonstratekindness,humanity,andrespect.


Document92Bradley,SandraLContinuedebateonvoluntaryeuthanasia.Australiannursingjournal(July1993)2011Jun18(11):3


Document93Feldman,JamesBass,PatriciaAEtomidate,sepsis,andinformedconsent.Annalsofemergencymedicine2011Jun57(6):7056authorreply706


Document94Keown,JohnTallis'sslipperyslope.BMJ(Clinicalresearched.)2011May25342:d3182


Document95Koch,TomAssisteddyingversusassistedliving.BMJ(Clinicalresearched.)2011May25342:d3184


Document96Zaki,SyedAhmedInformedconsentandwithdrawaloflifesupport.Indianpediatrics2011May748(5):409authorreply409



Document97Monod,StfanieChiolero,RenBla,ChristopheBenaroyo,LazareEthicalissuesinnutritionsupportofseverelydisabledelderlypersons:aguideforhealthprofessionals.JPEN.Journalofparenteralandenteralnutrition2011May35(3):295302Abstract:Providingorwithholdingnutritioninseverelydisabledelderlypersonsisachallengingdilemmaforfamilies,healthprofessionals,andinstitutions.Despitelimitedevidencethatnutritionsupportimprovesfunctionalstatusinvulnerableolderpersons,especiallythosesufferingfromdementia,theissueofnutritionsupportinthispopulationisstronglydebated.Nutritionmightbeconsideredabasicneedthatnotonlysustainslifebutprovidescomfortaswellbypatientsandtheirfamilies.Consequently,thedecisiontoprovideorwithholdnutritionsupportduringmedicalcareisoftencomplexandinvolvesclinical,legal,andethicalconsiderations.Thisarticleproposesaguideforhealthprofessionalstoappraiseethicalissuesrelatedtonutritionsupportinseverelydisabledolderpersons.Thisguideisbasedonan8stepprocesstoidentifythecomponentsofasituation,analyzeconflictingvaluesthatresultintheethicaldilemma,andeventuallyreachaconsensusforthemostrelevantplanofcaretoimplementinaspecificclinicalsituation.Avignetteispresentedtoillustratetheuseofthisguidewhenanalyzingaclinicalsituation.


Document98Chambaere,KennethBilsen,JohanCohen,JoachimOnwuteakaPhilipsen,BregjeDMortier,FreddyDeliens,LucTrendsinmedicalendoflifedecisionmakinginFlanders,Belgium199820012007.Medicaldecisionmaking:aninternationaljournaloftheSocietyforMedicalDecisionMaking2011MayJun31(3):50010Abstract:In2002,Belgiumsawtheenactmentof3lawsconcerningeuthanasia,palliativecare,andpatientrightsthatarelikelytoaffectendoflifedecisionmaking.Thisreportexaminestrendsintheoccurrenceanddecisionmakingprocessofendoflifepracticesindifferentpatientgroupssincetheselegalchanges.AlargescaleretrospectivesurveyinFlanders,Belgium,previouslyconductedin1998and2001,wasrepeatedin2007.Questionnairesregardingendoflifepracticesandtheprecedingdecisionmakingprocessweremailedtophysicianswhocertifiedarepresentativesample(N=6927)ofdeathcertificates.The2007responseratewas58.4%.Inpatientgroupsinwhichtheprevalenceoflifeendingdrugusewithoutexplicitpatientrequesthasdropped,performanceofeuthanasiaandassistedsuicidehasincreased.Theconsistentincreaseinintensifiedpainandsymptomalleviationwasfoundinallpatientgroupsexceptcancerpatients.In2007,competentpatientswereslightlymoreofteninvolvedinthediscussionofendoflifepracticesthaninpreviousyears.Overtheyears,involvementofthepatientindecisionmakingwasconsistentlymorelikelyamongyoungerpatients,cancerpatients,andthosedyingathome.Physiciansconsultedtheircolleaguesmoreoftenthaninpreviousyearsforeuthanasiaandnontreatmentdecisions.TheeuthanasialawandemergingpalliativecareculturehavesubstantiallyaffectedtheoccurrenceanddecisionmakingforendoflifepracticesinBelgium.Effortsarestillneededtoencouragesharedendoflifedecisionmaking,assomepatientswouldbenefitfromadvancecareplanning.


Document99Desikan,PrabhaSupremeCourtdelivershistoricjudgmentonArunaShanbaugcase.TheNationalmedicaljournalofIndia2011MayJun24(3):1901


Document100MartnHernndez,HLpezMessa,JBPrezVela,JLHerreroAnsola,P[ILCOR2010recommendations.Theevidenceevaluationprocessinresuscitation].=RecomendacionesILCOR2010.Elprocesodeevaluacindelaevidenciaenresucitacin.


Medicinaintensiva/SociedadEspaoladeMedicinaIntensivayUnidadesCoronarias2011May35(4):24955Abstract:TheconsensusdocumentontheScienceofResuscitationandEmergencyCardiacCarewithILCORTreatmentRecommendationsisaninvaluabletoolforquickly,simplyandrigorouslyestablishingtheevidenceonwhichtheResuscitationGuidelines2010arefounded.Wepresentamethodthathasbeenusedinthereviewprocessaccordingtoevidencebasedmedicine,whichcanbeconsideredarolemodelforbothindividualandcollectiveuseinclinicalpractice,notonlyinthefieldofresuscitationbutalsoinotherareasofmedicine.


Document101Braun,UrsulaKMcCullough,LaurenceBPreventinglifesustainingtreatmentbydefault.Annalsoffamilymedicine2011MayJun9(3):2506Abstract:Manyphysicianswillatsomepointcareforpatientswhowillreceivelifesustainingtreatmentbydefault,becausetherearenoinstructionsavailablefromthepatientastowhatkindofcareispreferred,andbecausesurrogatesarelikelytoaskforeverythingtobedonewhentheydonotknowapatient'spreferences.Weusethemethodsofethicsinformedbyqualitativefocusgroupresearchtoidentify5pathwaystolifesustainingtreatmentbydefaultoriginatingwiththepatient'spreferreddecisionmakingstyle:decidingforoneselforlettingothersdecide.Weemphasizepreventingtheethicallyunwelcomeoutcomeoflifesustainingtreatmentbydefaultbyincreasingthefrequencywithwhichpatientsmakecleardecisionsorclearlyexpresstheirvaluesandgoalsthattheythencommunicatetophysiciansorsurrogates.


Document102Scholes,JulieAlbarran,JohnWhat'sinthisissue?Nursingincriticalcare2011MayJun16(3):1112


Document103Pattison,NatalieEndoflifeincriticalcare:anemphasisoncare.Nursingincriticalcare2011MayJun16(3):1135


Document104Efstathiou,NikolaosClifford,ColletteThecriticalcarenurse'sroleinendoflifecare:issuesandchallenges.Nursingincriticalcare2011MayJun16(3):11623Abstract:ThepurposeofthisarticleistodiscussthechallengescriticalcarenursesfacewhenlookingafterpatientsneedingEndofLife(EoL)careincriticalcareenvironments.


Document105


Frost,DavidWCook,DeborahJHeyland,DarenKFowler,RobertAPatientandhealthcareprofessionalfactorsinfluencingendoflifedecisionmakingduringcriticalillness:asystematicreview.Criticalcaremedicine2011May39(5):117489Abstract:Theneedforbetterunderstandingofendoflifecarehasneverbeengreater.DebateaboutrecentU.S.healthcaresystemreformshashighlightedthatendoflifedecisionmakingiscontentious.Providingcompassionateendoflifecarethatisappropriateandinaccordancewithpatientwishesisanessentialcomponentofcriticalcare.Becausediscordcanundermineoptimalendoflifecare,knowledgeoffactorsthatinfluencedecisionmakingisimportant.Weperformedasystematicreviewtodeterminewhichfactorsareknowntoinfluenceendoflifedecisionmakingamongpatientsandhealthcareproviders.DATASOURCES,SELECTION,ANDABSTRACTION:WeconductedastructuredsearchofOvidMedlineforinterventionalandobservationalresearcharticlesincorporatingcriticalcareandendoflifedecisionmakingterms.


Document106Saager,LeifKurz,AndreaDeogaonkar,AnupaYou,JingMascha,EdwardJJahan,AliTurner,PatriciaLSessler,DanielITuran,AlparslanPreexistingdonotresuscitateordersarenotassociatedwithincreasedpostoperativemorbidityat30daysinsurgicalpatients.Criticalcaremedicine2011May39(5):103641Abstract:Toassesstherelationshipbetweenpreexistingdonotresuscitateordersandtheincidenceofpostoperative30dayminormorbidityinsurgicalpatients.


Document107Truog,RobertDDonotresuscitateordersinevolution:matchingmedicalinterventionswithpatientgoals.Criticalcaremedicine2011May39(5):12134


Document108Pleacher,KristineMProvidingagooddeath.Criticalcaremedicine2011May39(5):12356


Document109Joyner,NancyEDifficultchoices:forgoinglifesustainingtreatment.ThePrairierose2011MayJul80(2):710


Document110


Laventhal,NaomiSpelke,MBridgetAndrews,BreeLarkin,LKnollMeadow,WilliamJanvier,AnnieEthicsofresuscitationatdifferentstagesoflife:asurveyofperinatalphysicians.Pediatrics2011May127(5):e12219Abstract:WesurveyedUSneonatologistsandhighriskobstetriciansaboutpreferencesforresuscitationinethicallydifficultsituationstodeterminewhether(1)theirresponsesadheredtotraditionalethicalprinciplesofbestinterestsandpatientautonomyand(2)physicianspecialtyseemedtoinfluencetheresponse.


Document111Engstrm,Ingemar[Withdrawaloflifesupportcareisanethicaldecision].=Attavbrytaenlivsuppehllandebehandlingarettetisktbeslut.Lkartidningen2011May2531108(21):11689


Document112Thomas,RuthHSchusterBruce,MartinDonotattemptresuscitationorders,ethicsandtheMentalCapacityAct.Britishjournalofhospitalmedicine(London,England:2005)2011May72(5):25963


Document113Grainger,JoanneEuthanasiacontentiousissue.Australiannursingjournal(July1993)2011May18(10):3discussion3


Document114Dyer,ClareMotheraskscourttoletherbraindamageddaughterdie.BMJ(Clinicalresearched.)2011April18342:d2522


Document115Barazzetti,GaiaReichlin,MassimoLifeextension:abiomedicalgoal?Scientificprospects,ethicalconcerns.Swissmedicalweekly2011April13141:w13181Abstract:Thepotentialfordevelopmentofbiomedicaltechnologiescapableofextendingthehumanlifespanraisesatleasttwokindsofquestionsthatitisimportantbothtodistinguishandtoconnectwithoneanother:scientific,factualquestionsregardingthefeasibilityoflifeextensioninterventionsandquestionsconcerningtheethicalissuesrelatedtotheextensionoflifeandhealthspans.Thispaperprovidesanaccountofsomelifeextensioninterventionsconsideredtobeamongstthemostpromising,andpresentstheethicalquestionsraisedbytheprospectoftheirpursuit.Itissuggestedthatproblemsconcerningtheeffectsofthesetechnologiesonhealthcare


resourcesandonintergenerationalrelationshipswillbethemostdifficulttotackle.


Document116Curtis,JRandallTonelli,MarkRShareddecisionmakingintheICU:value,challenges,andlimitations.Americanjournalofrespiratoryandcriticalcaremedicine2011Apr1183(7):8401


Document117Kramer,DanielBKesselheim,AaronSSalberg,LisaBrock,DanWMaisel,WilliamHEthicalandlegalviewsregardingdeactivationofcardiacimplantableelectricaldevicesinpatientswithhypertrophiccardiomyopathy.TheAmericanjournalofcardiology2011Apr1107(7):10711075.e5Abstract:Littleisknownaboutpatients'viewssurroundingtheethicalandlegalaspectsofmanagingpacemakers(PMs)andimplantablecardioverterdefibrillators(ICDs)neartheendoflife.Patientswithhypertrophiccardiomyopathy(HC)areatheightenedriskofsuddencardiacdeathandarecommonrecipientsofsuchdevices.PatientswithHCrecruitedfromthemembershipoftheHypertrophicCardiomyopathyAssociationweresurveyedabouttheirclinicalhistories,advancecareplanning,legalknowledge,andethicalbeliefsrelatingtothewithdrawalofPMandICDtherapy.Themeanageofthe546patientswas49.1years,47%werewomen,and57%hadICDs.Only46%oftherespondentshadcompletedanadvancedirective,only51%hadahealthcareproxy,andcardiacimplantableelectricaldevices(CIEDs)werecommonlynotaddressedineither(92%and58%,respectively).ManypatientscharacterizeddeactivatingPMsorICDsaseuthanasiaorphysicianassistedsuicide(29%forPMsand17%forICDs),and>50%expresseduncertaintyregardingthelegalityofdevicedeactivation.PatientsvieweddeactivationofICDsandPMsasmorallydifferentfromotherlifesustainingtherapiessuchasmechanicalventilationanddialysis,andtheseviewsvariedsubstantiallyaccordingtotheCIEDtype(p

forinstance,accordingtotheguidelinesbyJAAM.Thebestpracticeselectedfortheterminallyilloughttobereasonableandsuitablefromtheaspectsofbothmedicalscienceandethics.


Document120Touyz,LZGTouyz,SJJAnappraisaloflife'sterminalphasesandeuthanasiaandtherighttodie.Currentoncology(Toronto,Ont.)2011Apr18(2):656


Document121Larsen,JVActiveeuthanasiapotentialabuseinSouthAfrica.SouthAfricanmedicaljournal=SuidAfrikaansetydskrifvirgeneeskunde2011Apr101(4):214


Document122Weng,LiJoynt,GavinMLee,AnnaDu,BinLeung,PatriciaPeng,JinmingGomersall,CharlesDHu,XiaoyunYap,HuiYChineseCriticalCareEthicsGroupAttitudestowardsethicalproblemsincriticalcaremedicine:theChineseperspective.Intensivecaremedicine2011Apr37(4):65564Abstract:Criticalcaredoctorsarefrequentlyfacedwithclinicalproblemsthathaveimportantethicalandmoraldimensions.WhileWesternattitudesandpracticearewelldocumented,littleisknownoftheattitudesorpracticeofChinesecriticalcaredoctors.


Document123Dreyfuss,DidierTowardtheendofrandomized,controlledtrialsintheintensivecareunit?Criticalcaremedicine2011Apr39(4):921authorreply921


Document124Wilkinson,DominicJCSavulescu,JulianKnowingwhentostop:futilityintheICU.Currentopinioninanaesthesiology2011Apr24(2):1605Abstract:Decisionstowithdraworwithholdpotentiallylifesustainingtreatmentarecommoninintensivecareandprecedethemajorityofdeaths.Whenfamiliesresistoropposedoctors'suggestionsthatitistimetostoptreatment,itisoftenunclearwhatshouldbedone.Thisreviewwillsummarizerecentliteraturearoundfutilityjudgementsinintensivecareemphasisingethicalandpracticalquestions.



Document125Dean,ErinAssisteddyingcommissionistoldofneedforrobustprotocols.Nursingstandard(RoyalCollegeofNursing(GreatBritain):1987)2011Apr27May325(34):7


Document126Joly,ClmenceGhaziElie,ElisabethMaillet,EricHannequin,DidierGudon,Elisabeth[Refractorysufferingsattheendoflife:Whichconsiderations,whichpropositions?].=Souffrancesrfractairesenfindevie:quellesrflexions,quellespropositions?Pressemdicale(Paris,France:1983)2011Apr40(4Pt1):3418Abstract:Refractorysufferingofterminallyillpeoplemaybephysical(pain,dyspnea,vomiting...)orexistential(spiritualsufferings,anxiousness...).Endoflifedecisionsareoftenaroundethics.Decisionmakingneartheendoflifeconsistsinwitholdingandwithdrawinglifesupporttreatmentandprescribingbothoftreatmentswithriskofdoubleeffectandsedationfordistress.InFrance,suchdecisionsaredefinedbythedeontologycodeandbythelawofApril22nd,2005concerningtheendoflifeandpatients'rights.Recommendationsfrommedicalsocietiesspecifythemeansofimplementation:obtainingothermedicalopinions,thepatient'sinformedconsentandfulltransparencyofthedecision(notedinthepatient'smedicalchart).


Document127McCormick,AndrewJSelfdetermination,therighttodie,andculture:aliteraturereview.Socialwork2011Apr56(2):11928Abstract:Selfdeterminationisaprimaryethicalprincipleunderlyingsocialworkpracticeinhealthcaresettings.Sincethe1970s,arighttodiemovementthatsharesthesocialworkcommitmenttoselfdeterminationhasgrownandinfluencesendoflifecaredecisions.However,theroleofcultureisnotablyabsentindiscussionsoftherighttodie.Aliteraturereviewwasconductedtoexploreselfdeterminationandtheroleofcultureinthecontextofthehistoryoftherighttodiemovement.Atotalof54articlesmetthecriteriaforinclusioninthereview.Ofthetotal,21relatedtoselfdetermination,and12relatedtoethnicityandcultureattheendoflife.Ahistorybasedonthereviewoftherighttodiemovementispresented.Thereviewfoundthatsocialworkerssupportpassivelyhasteningdeathandthatviewsofselfdeterminationareaffectedbybothlawandculture.Inresponse,socialworkerswillfacethreetasks:(1)becomingmorepublicintheirsupportforclientselfdeterminationasanimportantstandardinendoflifecare,(2)beingmoreexplicitinsupportofdiverseculturaltraditionsinendoflifedecisionmaking,and(3)expandingtheirtraditionaleducationalandbridgingrolesbetweenfamiliesandmedicalpersonnel.


Document128Gehlbach,ThomasGShinkunas,LauraAFormanHoffman,ValerieLThomas,KarlWSchmidt,GregoryAKaldjian,LaurisCCodestatusordersandgoalsofcareinthemedicalICU.Chest2011Apr139(4):8029Abstract:DecisionsaboutCPRinthemedicalICU(MICU)areimportant.However,discussionsaboutCPR(codestatusdiscussions)canbechallengingandmaybeincompleteiftheydonotaddressgoalsofcare.



Document129Stronegger,WillibaldJSchmlzer,ChristinRsky,EvaFreidl,WolfgangChangingattitudestowardseuthanasiaamongmedicalstudentsinAustria.Journalofmedicalethics2011Apr37(4):2279Abstract:InmostEuropeancountriestheattitudesregardingtheacceptabilityofactiveeuthanasiahaveclearlychangedinthepopulationsinceWorldWarII.Therefore,itisinterestingtoknowwhichtrendsinattitudesprevailamongthephysiciansofthefuture.


Document130Neuhaus,SusanJBattlefieldeuthanasiacourageouscompassionorwarcrime?TheMedicaljournalofAustralia2011Mar21194(6):3079Abstract:IssuesrelatingtovoluntaryeuthanasiathatarecurrentlybeingdebatedbyAustraliansocietyaredistinctlydifferentfromthoseencounteredbybattlefielddoctors.Doctorsinwarundertaketotreatthoseaffectedbyconflicttheirparticipationineuthanasiachallengestheprofession'sdefinitionof"dutyofcare".Euthanasiamustbedistinguishedfrom"triage"andmedicalwithdrawalofcare(whicharedecidedwithinamedicalfacilitywhere,althoughresourcesmaybelimited,comfortcarecanbeprovidedinthefaceoftreatmentfutility).Battlefieldeuthanasiaisadecisionmade,oftenimmediatelyafterhostileaction,inthefaceofapparentlyoverwhelminginjuriesthereisoftenlimitedavailabilityofpainrelief,supportsystemsorpalliationthatwouldbeavailableinacivilianenvironment.Thebattlefieldsituationisfurthercomplicatedbyissuesofpersonaldanger,theimmediacyofdecisionmakinganddifficultieswithdistinguishingciviliansfromcombatants.Regardlessofthecircumstancesonabattlefield,doctors,whethertheyareciviliansormembersofadefenceforce,aresubjecttothelawsofarmedconflict,thespecialprovisionsoftheGenevaConventionsandtheethicalcodesofthemedicalprofession.


Document131Berg,RonanMGMller,KirstenRossel,PeterJHancke[Howtoprotectacutelyill,unconsciouspatientsinconnectionwithdrugtrials?].=Hvordanbeskyttermanakutsyge,bevidstlsepatienteriforbindelsemedlgemiddelforsg?Ugeskriftforlaeger2011Mar21173(12):919


Document132Mudur,GanapatiIndiancourtsaysitmaysanctioneuthanasiainthefuture.BMJ(Clinicalresearched.)2011March11342:d1628


Document133ClaureDelGranado,RolandoMehta,RavindraLWithholdingandwithdrawingrenalsupportinacutekidneyinjury.Seminarsindialysis2011MarApr24(2):20814Abstract:Managementofcriticallyillpatientswithacutekidneyinjury(AKI)ismainlylimitedtosupportivetherapy,withdialysisasoneofthemaincomponents.Whetherornottoofferdialysisandwhentowithdrawdialysisisaone


ofthemanychoicesphysiciansfaceindailyclinicalpractice.Withholdingorwithdrawingrenalreplacementtherapyisacomplexdecisionanddependsonmanyinteractingfactors,whichareuniqueforeachpatientandtheirfamiliesandforthecareteam.Anevidencebasedguidelinewithninespecificrecommendationsformanagingpatientshasbeenavailablehoweverisinfrequentlyemployedtohelpclinicaldecisionmaking.Inthisreview,wediscusstheimportantissuesaffectingdecisionstowithholdorwithdrawdialysisinAKIpatientsandprovideanapproachformakingthesedecisionsforpatientmanagement.


Document134Carassiti,MZanzonico,RTambone,VEntropy:anunusualmethodology.Minervaanestesiologica2011Mar77(3):382authorreply383


Document135Solarino,BiagioBruno,FrancescoFrati,GiacomoDell'erba,AlessandroFrati,PaolaAnationalsurveyofItalianphysicians'attitudestowardsendoflifedecisionsfollowingthedeathofEluanaEnglaro.Intensivecaremedicine2011Mar37(3):5429Abstract:EthicalissuesregardingpatientcarehaverecentlybeenraisedinItalybythecaseofEluanaEnglaro,a36yearoldwomanwhoremainedinapersistentvegetativestate(PVS)for17years.TherearenospecificlawsonthebooksinItalyregardingeuthanasiaandphysicianassistedsuicide.InNovember2008,acontroversialdecisionbytheItalianSupremeCourtgrantedthewoman'sfatherhiswishtodiscontinuenutritionandhydrationprovidedtoher.Becauseofthishistoricdecision,theauthorscarriedoutasurveyofItalianphysicians'beliefsregardingendoflifepractices.


Document136Piers,RDBenoit,DDSchrauwen,WJVanDenNoortgate,NJDonotresuscitatedecisionsinalargetertiaryhospital:differencesbetweenwardsandresultsofahospitalwideintervention.ActaclinicaBelgica2011MarApr66(2):11622Abstract:Despitetheadventofpalliativecare,thequalityofdyinginthehospitalremainspoor.Differencesinqualityofendoflifepracticebetweenhospitalwardsarewellknowninclinicalpracticebutrarelyhavebeeninvestigated.


Document137BellocRocasalbas,MGirbes,ARJ[Endoflifedecisions,theDutchformthroughSpanisheyes].=Tomadedecisionesalfinaldelavida,elmodoneerlandsatravesdeojosespaoles.Medicinaintensiva/SociedadEspaoladeMedicinaIntensivayUnidadesCoronarias2011Mar35(2):1026Abstract:Abroad,butalsoinTheNetherlands,therearemanymisunderstandingsconcerningendoflifedecisionsandeuthanasia.Ingeneral,euthanasiadoesnotplayanyroleintheintensivecareunits,simplybecauseitdoesnotfulfilltheconditionstocarryitout.However,thereisstillconfusion,merelyduetotheassumptionthattheDutchsituationisdifferentbecauseoftheirlegislationoneuthanasia.Theuseoftheunclearterminologysuchas"passiveeuthanasia","voluntaryeuthanasia"or"involuntaryeuthanasia"contributestotheconfusionoflaypeopleand


physicians,andshouldthereforebeavoided.Endoflifedecisionsinintensivecarepatientsareinfactastructuralpartofworkofintensivists.Collectingallnecessaryinformationincludingthewishesandwillofthepatient,medicalexpertiseandacknowledginglimitationsofmedicaltreatmentwillhelptodeterminefutilityoftreatmentgoals.Onceitisdeterminedthatsurvivingtheintensivecareunitwithaqualityoflifeacceptableforthepatientisbeyondreach,thegoaloftreatmentshouldbeimprovedandthedyingprocessoptimized.Stoppingatreatmentmodalityattherequestofawillcompetentpatientorbecauseoffutilityisnoteuthanasia.


Document138Carlsson,JrgMansson,AndersOlsson,David[Deactivationofimplantabledefibrillatorsalsoanethicalissue.Writtenroutinesoftheprocessarenecessaryasillustratedbythedescribedcasereport].=Avstngningavimplanterbardefibrillatorocksenetiskfrga.Skriftligarutinerbehvs,visarbeskrivnafall.Lkartidningen2011Mar915108(10):5369


Document139Smets,TinneCohen,JoachimBilsen,JohanVanWesemael,YannaRurup,MetteLDeliens,LucAttitudesandexperiencesofBelgianphysiciansregardingeuthanasiapracticeandtheeuthanasialaw.Journalofpainandsymptommanagement2011Mar41(3):58093Abstract:Sincethelegalizationofeuthanasia,physiciansinBelgiummay,undercertainconditions,administerlifeendingdrugsattheexplicitrequestofapatient.


Document140Lachman,VickiDLeftventricularassistdevicedeactivation:ethicalissues.Medsurgnursing:officialjournaloftheAcademyofMedicalSurgicalNurses2011MarApr20(2):98100


Document141Siddiqui,MohammadFHolley,JeanLResidents'practicesandperceptionsaboutdonotresuscitateordersandpronouncingdeath:anopportunityforclinicaltraining.TheAmericanjournalofhospice&palliativecare2011Mar28(2):947Abstract:Although''Donotresuscitate''(DNR)ordersareamongthemostcommonlydiscussedpatientpreferencetreatmentmeasures,fewstudieshaveassessedinternalmedicineresidents'viewsonthiscomplextopic.Ourobjectivewastoassessresidentpracticesinestablishingcodestatus.Wealsoexaminedresidenttrainingandexperiencesinpronouncingdeath.


Document142Connolly,MichaelPLarkin,PhilipJ


Assisteddying:promotingapalliativecareapproach.AresponsetoGayLee.Internationaljournalofpalliativenursing2011Mar17(3):14950


Document143Roffey,PeterThangathurai,DuraiyahEthicalissuesrelatedtodirectnursingcaretime,comparedtotimespentchartinginintensivecareunits.TheJournalofclinicalethics2011Spring22(1):94


Document144FatherJohnTuohey,Hodges,MarianOEndoflife:POLSTreflectspatientwishes,clinicalreality.Healthprogress(SaintLouis,Mo.)2011MarApr92(2):604


Document145Johnson,LSydMTherighttodieintheminimallyconsciousstate.Journalofmedicalethics2011Mar37(3):1758Abstract:Therighttodiehasfordecadesbeenrecognisedforpersonsinavegetativestate,butthereremainscontroversyaboutendinglifesustainingmedicaltreatmentforpersonsintheminimallyconsciousstate(MCS).Thecontroversyisrootedinassumptionsaboutthemoralsignificanceofconsciousness,andthevalueoflifeforpatientswhoareconsciousandnotterminallyill.ThispaperevaluatestheseassumptionsinlightofevidencethatgeneratesconcernsaboutqualityoflifeintheMCS.ItisarguedthatsurrogatesshouldbepermittedtomakedecisionstowithdrawlifesustainingmedicaltreatmentfrompatientsintheMCS.


Document146Marker,RitaL.Endoflifedecisionsanddoubleeffect:howcanthisbewrongwhenitfeelssorightTheNationalCatholicBioethicsQuarterly2011Spring11(1):99119


Document147Hauskeller,Micha