Comment: Universality and diversity
Andrew Hoy
pp 224-224
The events in New York and Washington of 11 September 2001 have shocked us all. That the awful trauma of these terrorist attacks was visible through real-time television, and that they took place at the economic heart of the Western world, serves to highlight the uniqueness of the events. As I write this comment, the reverberations dominate our thinking. By the time you read it, decisive actions and reactions may well have unfolded across the world. The images in the news media of the World Trade Center have a powerful impact, resembling a warscape in their devastation. The twisted metal skeleton of the buildings and the heaps of rubble in New York evoke the remains of the Prefectural Industrial Promotion Hall in Hiroshima, and the cathedral in Coventry, after their bombings.
|
A palliative approach for COPD and heart failure?
Niels Chavannes
pp 225-227
Since its establishment, the hospice movement has focused on patients suffering from incurable malignant disease. It was felt that in this particular patient group the low quality of care and invasive nature of treatment had led to a devastating neglect of patient needs. Cancer is still the second biggest cause of death in the Western world, runner-up only to cardiovascular and cerebrovascular disease, and closely followed by chronic obstructive pulmonary disease (COPD). Furthermore, it is predicted that in the aging Western population the burden of both chronic heart failure (CHF) and COPD will continue to rise spectacularly (up to 70%) in the next decade, while the burden of cancer is expected to level off.
|
The use of psychostimulants in terminally ill patients
Donal Martin
pp 228-232
Psychomotor stimulants are currently renaissance drugs1 in some palliative care centres outside the UK for the treatment of depression, fatigue and weakness in the terminally ill. To date, there have been few placebo-controlled studies of their palliative care efficacy. The lack of such studies may relate historically to their introduction and subsequent degeneration into social abuse as drugs of dependency or to an overestimation of the severity of their side-effect profile.
|
Palliative medicine for all
Michèle Salamagne
pp 234-235
In 1976, the Council of Europe recommended that ‘prolonging life should not, in itself, be the sole aim of medical practice, which should place as much importance on alleviating suffering.’ Twentyfive years later, the care of terminally ill patients has advanced to such a point that it is now known by an internationally recognised name – palliative care – which claims to be an intrinsic part of medicine.
|
User involvement in palliative care services
David Oliviere
pp 238-241
In an important ethnographic study of women in a Brazilian shanty town, Nancy Shepherd-Hughes recounts how high expectancy of infant death shapes not only the notions of, but also the feelings and reactions that accompany losses of small children. Shepherd-Hughes comments how dead infants were comprehended as angels who had decided to go back to where they came from. The deaths were not followed by grief; the mothers did not shed any tears, and spoke of t he losses as blessings or a great relief. This attitude towards the demise of an infant challenges both Western notions of maternal bonding and the conception that it is necessarily traumatic to lose a child.
|
Bereavement – a social phenomenon?
Eva Reimers
pp 242-244
Following the collapse of communist rule in 1990 after 44 years, Albania became a democratic country. The transition has proved difficult – with severe unemployment, an influx of refugees from neighbouring countries and lack of funds. Healthcare provision is still far from adequate, as the country struggles to emerge from decades of isolation.
|
The development of terminal care in Albania
Maureen Newton
pp 246-249
Following the collapse of communist rule in 1990 after 44 years, Albania became a democratic country. The transition has proved difficult – with severe unemployment, an influx of refugees from neighbouring countries and lack of funds. Healthcare provision is still far from adequate, as the country struggles to emerge from decades of isolation.
|
Mental capacity assessment of terminally ill patients
Syed Qamar Abbas and Simon Dien
pp 250-252
Mental capacity refers to the mental ability of a person to do something binding in law, which may have legal implications not only for the person concerned but also for others. No mental illness necessarily confers or defers capacity conclusively, though most healthcare professionals may think otherwise. In 1988, a study in the USA suggested that, among doctors, 72% believed that a diagnosis of dementia automatically rendered a person incompetent to make a decision, be it physical or financial.
|
All-consuming pain
Boguslaw Block and Radoslaw Czosnowski
pp 253-255
The patient (Andrew) whose work we look at here was an art historian, lecturer in art and art conservationist. Throughout his life, Andrew had a habit of making painted notes – he had a sketchbook and would draw a picture in it whenever he had a free moment. In July 1994, when Andrew was 57, he was diagnosed with cancer. Between this time and his death in July 1995 he created a series of 34 pencil and charcoal drawings entitled ‘On the River Styx’. In the last two months of his life, when with great difficulty he began to come to terms with his fate, he opened up to his doctor, showed these drawings, spoke about the situations that had inspired some of them and told how he would, ‘like these drawings to help doctors and nurses understand how people with cancer feel about it’.
|