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PALLIATIVE CARE; HOSPICE; END OF LIFE CARE, ISSUES ON PAIN MANAGEMENT; ADVANCED DIRECTIVES; ETHICS & BIOETHICS:  Resources include links to other medical journals, books and reviews- also articles regarding removing nutrition a hydration (tube feeding) Terminal Sedation

  HOSPICE While hospice and palliative care share a similar philosophy they represent two different aspects of care, however both services may be provided in a person's home. The modern hospice movement was founded by Dame Cicely Saunders in 1967, in London, England.  Dr Balfour Mount heard about Saunders and decided he had to meet with her in person at St. Christopher's and learn more.  "It was ... one of the most stimulating single weeks in my life," Dr. Mount recalls. "Once I saw St. Christopher's, I saw there were solutions to that unnecessary suffering ... It was evident to me that that was where I wanted to die." In Canada, the U.K.,  the United States, and most other countries, hospice and palliative care provides an interdisciplinary team consisting of physicians, registered nurses, social workers, hospice chaplains, physiotherapists, occupational therapists, complimentary therapists, volunteers and, most importantly, the family.  For additional links not published on this site, see the LINKS  below (or click here)

  PALLIATIVE CARE   (see HOSPICE above) The modern use of the term palliative care is most often attributed to Dr. Balfour Mount, who became the father of Canada's palliative care movement in Canada.  Before the birth of palliative care, Dr Mount Mount said "There was abysmal inadequacy in the control of pain and all other symptoms"  at Montreal's Royal Victoria, which was considered one of the leading teaching hospitals in the country.  In 1976, Dr Mount lead Canadians the the birth of palliative care, in the new ward of Royal Victoria Hospital. (Read A Moral Force: The Story of Dr. Balfour Mount).   The American Academy of Hospice and Palliative Medicine provides this definition: "The term palliative care originally referred to the care of patients with terminal illnesses, but now refers to the care of patients with life-limiting illnesses, whether or not they are imminently dying."  It further defines palliative medicine as "the study and management of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is quality of life.  For additional links not published on this site, see the LINKS below (or click here)

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   PALLIATIVE CARE; HOSPICE; END OF LIFE CARE

LifeTree  important information on palliative care and the Culture of Death .. Warning: Who's Leading Palliative Care Now?  (This is a link only, to return to CHN, please use your back button, thank you.)

LAMENTATION AND EUTHANASIA  by Dr John F Scott   "False presuppositions about palliative care confuse the euthanasia debate. Palliative care, at a clinical and psychologic level is the affirmation of life and not a choosing of death. . . . Over the next decade I predict the  term, palliative care, will be "hijacked" by the euthanasia lobby. The deception is spreading that a person can have "death with dignity" only by choosing death through active or passive euthanasia. Unless we issue a strong challenge, palliative care may soon become a euphemism or synonym for choosing death, thus making a mockery of its origin as the active alternative to euthanasia.   [Dr. John F. Scott, emphasis added]

A Moral Force: The Story of Dr. Balfour Mount

Physician-assisted suicide v Palliative care: a tale of two cities "Proponents for the legalization of physician assisted suicide (PAS ) argue that it has been legal in Oregon state since 1997 and that it works well. They maintain that palliative and hospice care can co-exist comfortably with the option for PAS. My aim was to examine these claims, in two cities in the Northwest of America . . ."

Death by "choking" is a myth for Lou Gehrig's disease  In a phone conversation and letter, Dr Cicely Saunders tells Cheryl Eckstein, president of CHN that patients with ALS can die comfortably without a doctor hastening their death.

Ottawa Citizen's series on Palliative care From April 26, through to May 6, 2005, the Ottawa Citizen profiled a number of Canadian Physicians and their patients in a series called:  A Revolution in Dying.  CHN has posted the titles & links only, for your perusal

PALLIATIVE CARE: CARE OF DYING FAMILIES

Angels of Death Flourish In Hospice - Four Families Report.

Hospice Advocacy & Group Initiates Letter Writing Campaign 1/25/01 (same page as above)

Are Euthanasia Advocates Taking Over America's Hospice Industry?  Ron Panzer, president of the pro-life Hospice Patients Alliance (HPA), says there's a hidden threat inside the hospice industry that's been growing like a cancer for decades—and most people don't realize it until it's too late: Hospice workers all over the country are routinely killing patients.

Cast Me Not Off in Old Age

See ME! A poem and an amazing photograph

Mr Marty’s muddle: a superficial and selective case for euthanasia in Europe

Elisabeth Kubler-Ross  ~ August 25, 2004  Elisabeth Kubler-Ross dies  in her suburban Phoenix home. She was 78.   Kubler-Ross was born in Switzerland and gained international recognition for her ground breaking book  "On Death and Dying," published 1969.
 

NEW BOOK REVIEW Book Review by Dr Gerard Daly Challenging Medical Ethics 1 No Water- No Life: Hydration in the Dying   Compiled and edited by Dr Gillian Craig  

Hungering and Thirsting After Righteousness: Providing Nutrition and Hydration to Patients in the Persistent Vegetative State— Moving Beyond the Problems Toward a Christian Response Cindy Province R.N., M.S.N.  The Condition of the Persistent Vegetative State

TERMINAL SEDATION

Sedated to Death? When "comfort care" becomes dangerous "terminal sedation" (TS) by Nancy Valko RN  This article by Nancy Valko is a very serious and important article that I classify as "must read".  Cheryl Eckstein CHN

TERMINAL SEDATION IS IT GOOD PALLIATIVE CARE OR EUTHANASIA By RON PANZER.  In the USA "Hospice at its best is at risk for becoming hospice at its worst: simply a death mill where death is imposed upon the patient before the terminal illness would naturally take the patient's life."

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Dr Daly warns  "If hospices are above all criticism, and a blind eye is turned to covert euthanasia, there is a risk that, like Terri, other groups of vulnerable people who are not dying will be increasingly accepted by hospices. There is a risk that vulnerable patients who are disabled or elderly, might be misdiagnosed as terminally ill and sent to hospices where they will not receive life sustaining treatment."

 

  LINKS TO ARTICLES NOT ON OUR SITE

    The National Council for Palliative Care (U.K.)

    World Health Organization's definition of Palliative care for adults and children

International Observatory on End of Life Care (IOBELC) In the welcome letter from The International Observatory on End of Life Cahey say, " Our team of social scientists and clinicians at Lancaster collaborates with colleagues all around the world in an effort to provide research evidence to impact the development of hospice and palliative care. Do look for ways to get involved with us – through research collaboration, programmes of study, volunteering or grant support."    This is a very helpful cite for researched information on countries such as Mexico and their push for euthanasia. (Ed.,  CHN)

Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force  Palliative Medicine 2003; 17: 97 /101                           E.G., "a distinction is sometimes drawn between so-called `active' and `passive' euthanasia. It is our view that this distinction is inappropriate. On our interpretation, as well as according to the Dutch understanding,. . . euthanasia is active by definition and so `passive?  euthanasia is a contradiction in terms / in other words, there can be no such thing."  See link above (IOBELC) to search similar articles.

Palliative Care in Canada The Special Senate Committee on Euthanasia and Assisted Suicide Of Life and Death - Final Report June 1995  Appendix M 

Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window Journal of Pain and Symptom Management Vol. 33 No. 3 March 2007

   CHN LINK PAGE

    Be sure to visit CHN's LINK PAGE for information and sites helpful to these topics

LINKS TO SITES NOT ON OUR WEB SITE

LifeTree Bookmark this page - to keep alert regarding Articles on Stem Cell and Stem Cell Cloning Battle in North Carolina; also important information on palliative care and the Culture of Death

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   ISSUES ON PAIN MANAGEMENT

No one wants to see you suffer  We believe kill the not the Patient

We hope you find these articles helpful

   pain
 

The Pain Relief Promotion Act, Eric Chevlen, M.D.   (The following 4 links below are also on this page)

        Doctor attacks pain, defends pain treatment

        Researcher attempt to fight painkiller abuse  "For millions, pain is severe enough to be disabling; up to 6 million patients are on long-term opioid therapy. It's not just a question of suffering: Serious pain can actually worsen recovery from various ailments."

        Prisoners of Pain Why are millions of suffering Americans being denied the prescription drug relief they need?

        Drug maker admits misleading public "In the process, scores died as a result of OxyContin abuse and an even greater number became addicted to OxyContin," U.S. Atty. John Brownlee of the Western District of Virginia, whose office brought the case, said in a statement."

New Study Helps Dispel Myth That Opioids Hasten Death

Study: Morphine kills pain -- not patients

When Is a Pain Doctor a Drug Pusher?  All modern pain-management textbooks advocate “titration to effect” — in other words, in cases where opioids are helping, gradually increasing the dosage until either the pain is acceptably controlled or the side effects begin to outweigh the pain-relief benefits. But the vast majority of doctors don’t practice what the textbooks counsel. In part, this is because of the stigma associated with high-dose opioids, the fear that patients will become addicted and the fact that careful monitoring is very time-consuming. And most doctors have received virtually no training in medical school about managing pain: many hold the same misconceptions about addiction and dosage as the general public.

 Dr. William Hurwitz guilty on 16 counts of drug trafficking April 27, 2007,  9:00 pm

Dr Hurwitz' Juror's interviewed John Tierney, April 30, 2007 New York Times  "...he jury considered Dr. William Hurwitz to be a doctor dedicated to treating pain who didn’t intentionally prescribe drugs to be resold or abused. They said he didn’t appear to benefit financially from his patients’ drug dealing and that he wasn’t what they considered a conventional drug trafficker. . .So why did find him guilty of “knowingly and intentionally” distributing drugs “ ...?"

Pain Doctor, Dr W. Hurwitz's Begins His Re-Trial for Prescribing Pain Medication  April 2007: "This case is being watched closely by doctors and patients who must deal with issues surrounding pain medication. The government's prosecution of Dr. Hurwitz occurs in the context of a nationwide law enforcement campaign against the use of powerful analgesics to treat patients suffering from severe chronic pain..."   Note - The treatment, or undertreatment of pain is much talked about by proponents of euthanasia and Physician assisted suicide.   We who oppose euthanasia and PAS are deeply concerned for patients who are not treated, or undertreated for chronic non cancer pain, and pain that comes with terminal illness, as we agree far too many are suffering needlessly, and know such suffering can push patients over the edge of reason.    Editor, CHN
 

Use of opioid analgesics for the treatment of chronic noncancer pain – A consensus statement and guidelines from the Canada Pain Society

Pain Research and Management Use of opioid analgesics for the treatment of chronic noncancer pain

When Morphine Fails to Kill ~  By GINA KOLATA  (excellent overview; Ed., CHN)

DYING FOR RELIEF ". . . under-treatment of all pain is a national disgrace. . ."  "Prolonged pain destroys the quality of life." unfortunately, some patients fear "pain means the disease is getting worse."  Read why  Cheryl Eckstein believes too many patients are dying for relief!

DEA Withdraws Its Support Of Guidelines on Painkillers  

Painkiller phobia inflicts needless suffering

Adequate Pain Control Is A Human Right  (Article below on same page)

    If bad drivers rather than cars are responsible for most road deaths, why blame morphine and ignore bad prescribers?

Physician-assisted suicide v Palliative care: a tale of two cities

PALLIATIVE CARE  ~ PAIN MANAGEMENT Canada must help dying to go with dignity;  ~ Pain: Treating a Disease or Palliating a Symptom?

Death Due to Withdrawal from Narcotics Conclusions "To date, we have been unable to find a single documented case in which opiate withdrawal was the sufficient cause of death. We conclude that death due to withdrawal of narcotics may not occur."

Leaving Patients in Pain

D.E.A. DICTATES DOCTOR CONFUSION

DOCTOR IN VA. DRUG-TRAFFICKING CASE GRANTED NEW TRIAL

The American Pain Society position statement regarding Treatment of Pain at the End of Life  In 1996, The American Pain Society made a strong position statement regarding Treatment of Pain at the End of Life, arguing that suffering patients would turn less often to assisted suicide if appropriate pain treatment were available to them. The position of APS has not changed.  May 1, 2007. A Position Statement from the American Pain Society

The Use of Opioids for the Treatment of Chronic Pain  These publications, which have been endorsed by AAPM and APS, state that opioids, sometimes called "narcotic analgesics," are an essential part of a pain management plan. There is currently no nationally accepted consensus for the treatment of chronic pain not due to cancer, yet the economic and social costs of chronic pain are substantial, with estimates ranging in the tens of billions of dollars annually.

Psychological Aspects of Persistent Pain: Current State of the Science "...recent findings addressing psychological factors associated with poor or improved adjustment to pain. Another section of the review looks at behavioral and psychosocial interventions for persistent pain..."

Pain Can Kill "...he and his team demonstrated that pain repressed the body's immune system and could indirectly promote tumor growth, or in Liebeskind's stark phrase, "Pain can kill!"

Fibromyalgia: The misunderstood disease "...they have found is that for the same amount of damage or inflammation in the peripheral tissues, a fibromyalgia patient would feel significantly more pain than the average person."

"Back Pain Brain" ~"Journal Neurology  a very interesting look into That pain in your back could be more than uncomfortable. As this Scien/Central News video reports, for the first time researchers have found evidence that it could be shrinking your brain"

 
 "Undertreatment of Pain" AND "Pain and Suffering in History–Narratives of Science, Medicine and Culture."   There is currently no nationally accepted consensus for the treatment of chronic pain not due to cancer, yet the economic and social costs of chronic pain are substantial, with estimates ranging in the tens of billions of dollars annually.

   LINKS TO PAIN ARTICLES NOT ON OUR SITE

AMERICAN PAIN SOCIETY Link to the society and their resources

Pain Medicine

http://www.blackwell-synergy.com/doi/abs/10.1046/j.1526-4637.2002.02003.x?cookieSet=1&journalCode=pme

Chronic Pain Coping Inventory (CPCI)

http://www1.va.gov/hsrd/for_researchers/measurement/instrument/instrument_reviews2.cfm?detail=65

Local research team receives $1.6 million to improve pediatric pain management in Thailand  "Pain is a global health problem, and children are more at risk than adults for untreated pain from surgery, injury, cancer, and other disease," commented Dr. Finley. "Children in developing countries have less access to pain care than those in Canada. Although pain causes immediate and prolonged suffering for both the child and his or her family, it is neither expensive nor difficult to prevent or treat most pain. We are extremely grateful for this funding opportunity, which will allow us to create a program to overcome barriers of attitude and knowledge. The approaches developed will not only help children in Thailand, but also in Canada and elsewhere in the world."

Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards Diane E. Hoffmann and Anita J. Tarzian Journal of Law, Medicine & Ethics, 31 (2003): 21–40. © 2003 by the American Society of Law, Medicine & Ethics. "Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids.  Surveys have shown that physicians fear potential disciplinary action for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in some cases, disciplined physicians for such prescribing. While in virtually all of these cases the  disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment"  To read this lengthy article in full, click on above link.

Some physicians are so opposed to use of opioids, they will go to any length they can to make it unavailable.  See Subject: Texas State Board of Medical Examiners Proposed Change of Rule Chapter 170. Authority of Physician to Prescribe for the Treatment of Pain  followed by  TEXAS STATE BOARD OF MEDICAL EXAMINERS

"Pain and Suffering in History–Narratives of Science, Medicine and Culture."  Includes Measuring Pain in Experimental Subjects

DIRECTORY OF HEALTH ORGANIZATIONS - An exhaustive list of every organization related to medicine - including research, labs, pain clinics A - Z from the National Library of Medicine

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  GERIATRICS -ELDERLY 
 

  Don't forget Mom on Mother's Day, send free E-card  Don't let being separated by emotional distance or by multiple time zones hold you back from remembering Mom.  If your mother has passed away, consider sending a cheery note to someone who is like a mom to you, or visiting an elderly person you know is alone.

See ME! A poem and an amazing photograph

Restraint reduction Note from CHN: I think anyone who has a loved one or friend in long term care, or nursing home should take the time to peruse this PDF file - it may help to assess how your loved one is doing, and help prevent possible abuse

Cast Me Not Off in Old Age"

Major overhaul needed in end-of life care for patients with dementia

Will to live in the terminally ill.

Choosing Death Over Dependence 

LAMENTATION AND EUTHANASIA  by Dr John F Scott

Depression A study in the Scriptures  FYI: Check the side bar "Depression linked to cancer in elderly"

Nursing Home Abuse and Neglect Resource Center resources - help on how to: prevent nursing home abuse and neglect; recognize nursing home abuse and neglect;  stop nursing home abuse and neglect.

REDUCING THE RISK OF SUICIDE IDEATION BY MANAGING PAIN AND TREATING UNDERLYING DEPRESSION Barbara Rubel, MA, CBS, CPBC

Victorian Supreme Court makes landmark Australian ruling on tube feeding Case of 69 year old man having feeding tube removed

Man's trial for mother's death begins

The American Pain Society position statement regarding Treatment of Pain at the End of Life  In 1996, The American Pain Society made a strong position statement regarding Treatment of Pain at the End of Life, arguing that suffering patients would turn less often to assisted suicide if appropriate pain treatment were available to them. The position of APS has not changed.  May 1, 2007. A Position Statement from the American Pain Society

  CHN LINK PAGE

    Be sure to visit CHN's LINK PAGE for information and sites helpful to these topics

LINKS to articles not on our web site

PREVENT SUICIDE.COM  Comprehensive web page - includes crucial information regarding the elderly.  

Premier's Council on the Status of Persons with Disabilities The Premier's Council aims to improve the lives of persons with disabilities. We do this by listening to issues of the disability community, and communicating them to members of government. Includes help for Seniors and programs (Alberta Canada)top

   ADVANCED DIRECTIVES  LIVING WILLS

Living Wills/Advance Directives  Archive - read this before signing any advance directive. "The bias against treatment in some advance directives is so strong as to limit the autonomy of the health care team and informal carers. For instance, some suggested directives dictate that in the event of Alzheimer's disease all life- sustaining treatment should cease this would forbid the giving of insulin to a diabetic patient with Alzheimer's disease if the directive were legally binding. Withdrawal of insulin in these circumstances might well be morally objectionable to the whole health care team, and it is hard to see how the autonomy of health care professionals could be safeguarded if such directives were legally binding. Another example would be a legal document specifying no surgery, which could prevent the pinning of a fractured hip. [HL. . . , Vol. II, 13.7.93:208]

Advance directives Doctors may not comply By Helen Fields  

The Culture of Death Who Will Decide When You Should Die (living wills) by Nancy Valko, RN

Living wills do not work

(see Living wills do not work)

LINKS  To sites & articles not published on this website:

        Better Alternatives to the 'Living Will' : The Durable Power of Attorney for Health Care and The Will To Live

   ETHICS BIOETHICS
 

Book Review by Dr Gerard Daly Challenging Medical Ethics 1 No Water- No Life: Hydration in the Dying   Compiled and edited by Dr Gillian Craig 

Challenging Medical Ethics Volume 2 ~ Patients in Danger; The Dark Side of Medical Ethics

Hungering and Thirsting After Righteousness: Providing Nutrition and Hydration to Patients in the Persistent Vegetative State— Moving Beyond the Problems Toward a Christian Response Cindy Province R.N., M.S.N.  The Condition of the Persistent Vegetative State

What is a Person?

Viktor Frankl at Ninety: An Interview by Matthew Scully  

   LINKS