Barry Ashpole Media Watch (#467)

Barry Ashpole Media Watch

The latest issue of  Media Watch, compiled and annotated by Barry R. Ashpole (Ontario, Canada) can now be downloaded here. More reports can be found at IPCRC.NET

Articles from Asia Pacific Region

Australia – Doctors blame many factors for futile care, themselves included

AUSTRALIA | Reuters – 17 June 2016 – Doctors who were asked about causes of inappropriate care at the end of life didn’t have to look far to place blame. They blamed themselves. Australian researchers interviewed 96 physicians from 10 medical specialties and asked them to describe situations when patients received end-oflife care that the doctors felt was inappropriate.1 Futile medical treatment at the end of life has been shown to harm patients, cause moral distress to clinicians and waste scarce resources… But 96% of physicians pointed to themselves – or “doctor-related factors” – as the main drivers of futile treatment. Poor communication, emotional attachment to patients, and aversion to death were also among the causes they cited. Patient-related factors were important, too. Ninety-one percent of the doctors cited reasons such as family or patient requests for treatment, prognostic uncertainty and not knowing the patient’s wishes as contributors to inappropriate care. Close to 70% of the surveyed doctors also cited hospital-related causes, such as specializations, medical hierarchy and time pressure, as factors in futile care.

Asia – End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive & Critical Care Medicine

JOURNAL OF CRITICAL CARE, 2016;34:125- 130. The objective [of the Task Force] was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care (EOLC) in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions. The complexity of EOLC in the ICU, particularly relating to withholding and withdrawing life-sustaining treatment while ensuring the alleviation of suffering, within different ethical and cultural environments is recognized. Although no single statement can therefore be regarded as a criterion standard applicable to all countries and societies, the World Federation of Societies of Intensive and Critical Care Medicine endorses and encourages the role of member societies to lead the debate regarding EOLC in the ICU within each country and to take a leading role in developing national guidelines and recommendations within each country.

Korea – Hospice palliative care in South Korea: Past, present, and future

KOREAN JOURNAL OF HOSPICE & PALLIATIVE CARE, 2016;19(2):99-108. Hospice palliative care (HPC) in Korea has developed steadily since its introduction in 1965. Currently, it is targeted only towards terminal cancer patients and their families, and the national health insurance scheme covers only inpatient hospice care for said patients. In recent years, healthcare professionals and policy makers have began to recognize the need for HPC services in diverse settings including outside hospital boundaries, and for all terminally-ill patients. A law on HPC passed in January 2016 allows terminally-ill patients to refuse life-sustaining treatments, and will likely facilitate further development of HPC services. It is critical for the government and all interested parties in the medical, academic and social sectors to collaborate to ensure its success once it takes effect in 2017. This article briefly reviews the half-century history of HPC in Korea, and discusses how to prepare for and cope with death and, thereby, improve the quality of death.

Article highlighted to be of particular interest:

Compromised autonomy: When families pressure patients to change their wishes

JOURNAL OF HOSPICE & PALLIATIVE NURSING | Online – 15 June 2016 – Living with a life-threatening illness is extraordinarily challenging. This challenge intensifies when patients struggle to weigh personal and familial interests when facing difficult medical decisions. When patients are unduly pressured by their families to make medical decisions that are not in line with previously held values, beliefs, or perspectives, autonomy is compromised. A case example, based on a clinical ethics consultation, is used to highlight the complexities of compromised autonomy secondary to family coercion and manipulation at the end of life. Decision making in the context of family involvement and relational autonomy is explored along with effects of caregiver stressors, patient/family disagreements, and the nuances of substituted judgment. The article closes with a discussion of universal strategies for best working with and advocating for patients who are experiencing compromised autonomy.