New Study Links Higher BMI to Lower-Quality End-of-Life Care

Pittsburgh: A new study authored by a University of Pittsburgh researcher suggests that the heavier someone is, the less likely they are to receive quality end-of-life care, including hospice care and the chance to die at home.The study was led by John Harris, M.D., M.Sc., who has recently been appointed as an assistant professor of obstetrics, gynecology and reproductive sciences at Pitt’s School of Medicine and Magee-Womens Hospital of UPMC. Dr. Harris conducted the research during his fellowship at the University of Michigan Institute for Healthcare Policy and Innovation (IHPI), and the findings are published today in the Annals of Internal Medicine.

Heart failure patients are less likely to receive end of life care

British Heart Foundation: Heart failure patients are less likely to receive palliative care than people with terminal cancer, according to a report. ‘Triggers for Palliative Care’, a report published by Marie Curie, says that heart failure patients are currently less likely to receive palliative care than people with terminal cancer because the less predictable progression of heart failure makes it more challenging for clinicians to identify when a patient is approaching the end of their life.

End-of-life care: no, we don’t all want ‘whatever it takes’ to prolong life

TheConversation: We all die eventually, of course, but these days it’s very hard for doctors and loved ones to let patients and relatives die without first doing “whatever it takes” to try to keep them alive. That is, unless they’ve left clear instructions to the contrary. The overwhelming priority for doctors is to save life. In the last few decades, technologies have progressed so far and fast that doctors are able to embark on treatments that until recently did not exist, or were too risky to consider.

Why are patients in permanent comas routinely kept alive?

TheConversation: Aruna Shanbaug died with pneumonia in May 2015 after 42 years in a vegetative state. She was 25 years old when, in 1973, she was raped and strangled, leaving her with severe brain damage. Her survival for so long is testimony to the dedicated care provided for her by generations of nurses at the hospital in Mumbai where she had worked. But should we routinely deliver life-prolonging treatments over years or even decades to people who have no realistic chance of ever regaining consciousness?

We all deserve the right to die without pain or fear, but assisted suicide won’t fix that

TheConversation: What connects these two recent news stories? Jeffrey Spector, a 54-year-old businessman with a spinal tumour, travels to Dignitas in Zurich to commit suicide, with support from his family; and the Health Service Ombudsman publishes a report called “Dying without Dignity”, which criticises the end-of-life care provided by the NHS. Campaigners for legal reform argue that Spector’s choice of death shows his search for dignity at the end of life and the desire to retain control: in a word, “autonomy”. But the ombudsman’s report – and a closer reading of the cases which constantly appear in the media – suggest it’s not autonomy. It’s mainly fear.

Dying matters. That’s why we must listen to patients' wishes

TheConversation: My mother, Sheila Kitzinger, died last month, with good symptom management and with as much choice and control as possible. Her written “Advance Decision” helped ensure that her wishes were followed and she died at home, cared for by her family. Her experience contrasts starkly with that of my sister, Polly Kitzinger, who was severely brain injured in a car crash six years ago. Polly was subject to a series of life-sustaining interventions (while she was first unconscious and then minimally conscious) that we, her family, believe she would have refused if she had been able. My sister’s wishes were not recorded in a written Advance Decision. This meant that it was not possible to ensure that her own passionately expressed prior views were respected. Whatever one’s own individual, family or cultural beliefs, a key question for us all is: “How can we ensure good care, including respect for our values, when we are at our most vulnerable – on the cusp between life and death?”

Never Too Early to Consider End-of-life Wishes

Connecticut University. US: Most cases of disagreements over patients’ wishes for end-of-life care that have made national headlines have typically involved previously healthy people who didn’t think the conversation was relevant to them. Dr. Susan Levine, medical director of UConn Health’s general medicine practice, says it’s never too early to plan for end-of-life decisions in the event you become unable to speak for yourself.