Barry Ashpole Media Watch (#468)

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

Thailand – Terminally ill need home-based care

THAILAND | The Bangkok Post – 22 June 2016 – In Thailand, we mostly take care of terminally ill patients with what is called “sustaining” care in hospitals. In fact, most of these patients would prefer to stay at home where things are familiar rather than in a hospital. But Thailand does not have the necessary conditions in place, apart from some informal arrangements, to make this possible. Seeing how our neighbours Singapore and Malaysia approach this issue might help us understand it better and acknowledge the importance of home-based care for terminally ill patients. While home-based care doesn’t mean patients will live longer, their passing is likely to be more peaceful than it would in the institutional surroundings of a hospital. Singapore and Malaysia have long recognised the importance of home-based care for terminally ill patients, providing “home hospice” services for more than 25 years. Services are provided by charities in those two countries free of charge or for very little, reducing the financial burden on patients and their families. While the services provided in the two countries are quite similar, the financial and human resource support they receive varies. http://goo.gl/NlHmYk

Hong Kong – Last wish: Hong Kong survey reveals most elderly would rather die in hospital than at home

CHINA (Hong Kong) | The South China Morning Post (Hong Kong) – 21 June 2016 – Dying at home might be a solution to ease overcrowding in public wards, but the idea might spark a debate in the community as a survey undertaken by a local hospital’s palliative care (PC) unit found that only about 14% of patients receptive to the idea. Instead of pushing the trend of dying at home, an expert in PC suggested that the government could first try the concept in elderly care homes, which have better manpower and facilities. http://goo.gl/AJoJ48

Australia – Cardiac Implantable Electronic Devices and End-of-Life Care: An Australian Perspective

HEART, LUNG & CIRCULATION, 2016;25(8):814-819. Cardiac implantable electronic devices (pacemakers and defibrillators) are increasingly common in modern cardiology practice, and health professionals from a variety of specialties will encounter patients with such devices on a frequent basis. This article will focus on the subset of patients who may request, or be appropriate for, device deactivation and discuss the issues surrounding end-of-life decisions, along with the ethical and legal implications of device deactivation. http://goo.gl/yyFHHE

Article highlighted to be of particular interest:

Reason-giving and medical futility: Contrasting legal and social discourse in the U.S. with the U.K. and Ontario, Canada

Chest (American College of Chest Physicians) | Online – 11 June 2016 – Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. The authors describe three recent cases from different countries (the U.S., U.K., and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, they define the continuum of clinical and social utility among different types of dispute resolution processes, and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. The authors argue precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This paper highlights the lack of such rulings within the U.S. http://goo.gl/D2xCso

Palliative care ethics: A case commentary on discontinuing interventions at the end of life

The American Journal of Bioethics, 2016;16(7):58-60. Hospitals have widely differing policies on whether and when health care teams may or must refuse to provide interventions deemed medically futile. Some hospitals never permit health care providers to override patient/surrogate requests for such interventions. Many other hospitals have futility policies that only permit overriding patient/surrogate requests for physiologically futile interventions. Some hospitals permit health care teams to withhold interventions that a health care team (or review body) deems to be futile because they: 1) Offer little chance of prolonging a patient’s life; 2) Are unseemly, only offer disproportionate harms; and/or 3) Are insufficient to enable the patient to live outside of an acute care hospital. http://goo.gl/4MzH0Y