Group items tagged

'...This, in short, is how Christian belief figures into literary fiction in our place and time: as something between a dead language and a hangover. Forgive me if I exaggerate. But if any patch of our culture can be said to be post-Christian, it is literature. Half a century after Flannery O'Connor, Walker Percy, Reynolds Price and John Updike presented themselves as novelists with what O'Connor called "Christian convictions," their would-be successors are thin on the ground. So are works of fiction about the quan­daries of Christian belief. '...Where has the novel of belief gone? The obvious answer is that it has gone where belief itself has gone. In America today Christianity is highly visible in public life but marginal or of no consequence in a great many individual lives. For the first time in our history it is possible to speak of Christianity matter-of-factly as one religion among many; for the first time it is possible to leave it out of the conversation altogether. This development places the believer on a frontier again, at the beginning of a new adventure; it means that the Christian who was born here is a stranger in a strange land no less than the Sikhs, Muslims, Hindus, Buddhists, Soviet Jews .... 'The religious encounter of the kind O'Connor described forces a person to ask how belief figures into his or her own life and how to decide just what is true in it, what is worth acting on.... When we talk about belief we talk about what is permissible - about the sex abuse scandal or school prayer or whether the church should open its basement to 12‑step everything. What about the whole story? Is it our story? Is belief believable? There the story ends - right where it ought to begin.... ' This refusal to grant belief any explanatory power shows purity and toughness on the writer's part, but it also calls to mind what my Catholic ancestors called scrupulosity, an avoidance that comes at the cost of fullness of life. That - or it may show that the

'...This, in short, is how Christian belief figures into literary fiction in our place and time: as something between a dead language and a hangover. Forgive me if I exaggerate. But if any patch of our culture can be said to be post-Christian, it is literature. Half a century after Flannery O'Connor, Walker Percy, Reynolds Price and John Updike presented themselves as novelists with what O'Connor called "Christian convictions," their would-be successors are thin on the ground. So are works of fiction about the quan­daries of Christian belief. '...Where has the novel of belief gone? The obvious answer is that it has gone where belief itself has gone. In America today Christianity is highly visible in public life but marginal or of no consequence in a great many individual lives. For the first time in our history it is possible to speak of Christianity matter-of-factly as one religion among many; for the first time it is possible to leave it out of the conversation altogether. This development places the believer on a frontier again, at the beginning of a new adventure; it means that the Christian who was born here is a stranger in a strange land no less than the Sikhs, Muslims, Hindus, Buddhists, Soviet Jews .... 'The religious encounter of the kind O'Connor described forces a person to ask how belief figures into his or her own life and how to decide just what is true in it, what is worth acting on.... When we talk about belief we talk about what is permissible - about the sex abuse scandal or school prayer or whether the church should open its basement to 12‑step everything. What about the whole story? Is it our story? Is belief believable? There the story ends - right where it ought to begin.... ' This refusal to grant belief any explanatory power shows purity and toughness on the writer's part, but it also calls to mind what my Catholic ancestors called scrupulosity, an avoidance that comes at the cost of fullness of life. That - or it may show that the

The researchers found that in areas where end-of-life care costs were normally high, having an advance directive significantly lowered the cost of care. On average, end-of-life care spending was $5,585 less per person in the high-spending regions when someone had an advance directive. > Having an advance directive didn't necessarily limit the initiation of aggressive treatments, but seemed to lead to their earlier withdrawal. Author said this finding was particularly important because some people make the argument that having an advance directive might limit all of the care you receive at the end of your life. But, this finding shows that while treatments are often started, for "patients with an advance directive, there's an earlier recognition of when treatments aren't working and when it's time to go to hospice."

'If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing - except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions "a hidden human rights emergency." I never knew it until I started poking around, but this particular kind of discriminatory doctoring has a name. It's called "diagnostic overshadowing." According to a review of studies done by the Institute of Psychiatry at King's College, London, it happens a lot. As a result, people with a serious mental illness - including bipolar disorder, major depression, schizophrenia and schizoaffective disorder - end up with wrong diagnoses and are under-treated. That is a problem, because if yo

"...beyond the medical advances, Dr. DeBakey's story is emblematic of the difficulties that often accompany care at the end of life. It is a story of debates over how far to go in treating someone so old, ... and risky decisions that, while still being argued over, clearly saved Dr. DeBakey's life. It is also a story of Dr. DeBakey himself, a strong-willed pioneer who at one point was willing to die, concedes he was at times in denial about how sick he was and is now plowing into life with as much zest and verve as ever. But Dr. DeBakey's rescue almost never happened. He refused to be admitted to a hospital until late January. As his health deteriorated and he became unresponsive in the hospital in early February, his surgical partner of 40 years, Dr. George P. Noon, decided an operation was the only way to save his life. But the hospital's anesthesiologists refused to put Dr. DeBakey to sleep because such an operation had never been performed on someone his age and in his condition. Also, they said Dr. DeBakey had signed a directive that forbade surgery. As the hospital's ethics committee debated in a late-night emergency meeting on the 12th floor of Methodist Hospital, Dr. DeBakey's wife, Katrin, barged in to demand that the operation begin immediately.

From: Keating N, et al "Physician factors associated with discussions about end-of-life care" Cancer 2010; DOI: 10.1002/cncr.24761.

>'With unrealistic expectations of our ability to prolong life, with death as an unfamiliar and unnatural event, and without a realistic, tactile sense of how much a worn-out elderly patient is suffering, it's easy for patients and families to keep insisting on more tests, more medications, more procedures. >Doing something often feels better than doing nothing. Inaction feeds the sense of guilt-ridden ineptness family members already feel as they ask themselves, "Why can't I do more for this person I love so much?" >...At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. We've committed ourselves to relieving suffering, not causing it. A retired nurse once wrote to me: "I am so glad I don't have to hurt old people any more." '

Discussion of palliative sedation at end of life (Franklin Hospital Hospice Unit, NSLIJHealth System & Hospice Care Network of L.I.)

Pro's & con's on assisted suicide, & adequate support for patients & caregivers at end-of-life - initiated by letter by Janice Lynch Schuster, at Ctr for Elder Care & Advanced Illness, Altarum Institute

NYH palliativist fights for her own life to the end

>"...Offering a default option of opting in, rather than opting out (as many have suggested with organ donations as well) doesn't take away choice but guides us to make better ones, according to Richard H. Thaler, an economics professor at the University of Chicago, and Cass R. Sunstein, a professor at Chicago's law school, authors of "Nudge: Improving Decisions About Health, Wealth and Happiness". Making choices can be most difficult in the area of health. While we don't want to go back to the days when doctors unilaterally determined what was best, there may be ways of changing policy so that families are not forced to make unbearable choices. >Professor Iyengar and some colleagues compared how American and French families coped after making the heart-wrenching decision to withdraw life-sustaining treatment from an infant. In the United States, parents must make the decision to end the treatment, while in France, the doctors decide, unless explicitly challenged by the parents. >French families weren't as angry or confused about what had happened, and focused much less on how things might have been or should have been than the American parents.

Ben Rich - from law to health law & bioethics. See also: Rich BA. Prognosis terminal: truth-telling in the context of end-of-life care. Camb Q Healthc Ethics 2014;23:209-19.

Readers largely support measures to allow death in dignified environment with palliative approach, as opposed to repeated aggressive interventions that are rarely successful when the prognosis is poor.

Quality of living & dying

Palliative care program at Montefiore Hospital

The chilling dilemma of "the unbefriended elderly," who don't have family or close friends to make medical decisions on their behalf if they can't speak for themselves, generated a bunch of ideas the last time we discussed it. "I would much rather pay a professional, whom I get to know and who knows me, to make the decisions," she wrote. "That way it is an objective decision-maker based on the priorities I have discussed with him/her before my incapacitation." Elizabeth, it turns out other people have been thinking the same way.

Legal PAS at EOL in Oregon, Wash, Montana & Vt states - vs prosecution in Penna (req of 93yo failing man).