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'You Promised Me I Wouldn't Die Like This!': A Bad Death as a Medical Emergency

'You Promised Me I Wouldn't Die Like This!': A Bad Death as a Medical Emergency Abstract DYING IS a time of vulnerability and potential. Ideally, it can be a time of spiritual healing and personal connection, but it can also be dominated by physical symptoms and fear of the future. Dying patients depend on their physicians, nurses, and social workers to approach them with skill, knowledge, caring, and compassion.1-5 The core commitment made by health care providers to their dying patients is nonabandonment—that no matter what happens, they will be there to work through problems together with the patient and family.6,7 There is a profound difference between facing an uncertain future with caring, skilled partners and facing it alone. One of our goals in working with the dying is to help them try to achieve a "good death."8-10 The meaning of this idealized concept may be highly individual, but there are likely to be some common objectives. The first is to die in References 1. Wanzer SH, Adelstein SJ, Cranford RE, et al. The physician's responsibility toward hopelessly ill patients. N Engl J Med . 1984;310:955-959.Crossref 2. Wanzer SH, Federman DD, Adelstein SJ, et al. The physician's responsibility toward hopelessly ill patients: a second look. N Engl J Med . 1989;320:844-849.Crossref 3. Seale CF. What happens in hospices: a review of research evidence. Soc Sci Med . 1989;28: 551-559.Crossref 4. Wallston KA, Burger C, Smith RA, Baugher RJ. Comparing the quality of death for hospice and non-hospice cancer patients. Med Care . 1988; 26:177-182.Crossref 5. Rhymes J. Hospice care in America. JAMA . 1990; 264:369-372.Crossref 6. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med . 1995; 122:368-374.Crossref 7. Cassel EJ. The Nature of Suffering and the Goals of Medicine . New York, NY: Oxford University Press Inc; 1991. 8. Aries P. The Hour of Our Death . New York, NY: Oxford University Press Inc; 1981. 9. Loxterkamp D. A good death is hard to find: preliminary reports of a hospice doctor. JAm Board Fam Pract . 1993;6:415-417. 10. Nuland SB. How We Die: Reflections on Life's Final Chapter . New York, NY: Alfred A Knopf Inc; 1994. 11. Quill TE. 'Doctor I want to die: will you help me?' JAMA . 1993;270:870-873.Crossref 12. Block SD, Billings JA. Patient requests to hasten death: evaluation and management in terminal care. Arch Intern Med . 1994;154:2039-2047.Crossref 13. Walsh TTD. Symptom control in patients with advanced cancer. Am J Hospice Palliat Care . 1992; 6:32-40.Crossref 14. Cohen MH, Johnston-Anderson A, Krasnow SH, Wadleigh RG. Treatment of intractable dyspnea: clinical and ethical issues. Cancer Invest . 1992; 10:317-321.Crossref 15. Cohen SR, Mount BM. Quality of life in terminal illness: defining and measuring subjective well-being in the dying. J Palliat Care . 1992;8:40-45. 16. Broadfield L. Evaluation of palliative care: current status and future directions. J Palliat Care . 1988;4:21-28. 17. Patt RB, ed. Cancer Pain . Philadelphia, Pa: JB Lippincott; 1993. 18. Solomon MZ, O'Donnell L, Jennings B, et al. Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health . 1993;83:14-23.Crossref 19. Quill TE. Death and Dignity: Making Choices and Taking Charge . New York, NY: WW Norton & Co Inc; 1993. 20. Kasting GA. The nonnecessity of euthanasia. In: Humber JM, Almeder RF, Kasting GA, eds. Physician-Assisted Death . Clifton, NJ: Humana Press; 1993:25-45. 21. Dobratz MC, Wade R, Herbst L, Ryndes T. Pain efficacy in home hospice patients: a longitudinal study. Cancer Nurs . 1991;14:20-26.Crossref 22. Saunders C. Pain and impending death. In: Wall PD, Melzack R, eds. Textbook of Pain . New York, NY: Churchill Livingstone Inc; 1984:472-478. 23. Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR. Symptom prevalence and control during cancer patients' last days of life. J Palliat Care . 1990;6:7-11. 24. Rachels J. Active and passive euthanasia. N Engl J Med . 1975;292:78-80.Crossref 25. Brody H. Causing, intending, and assisting death. J Clin Ethics . 1993:4:112-117. 26. Marquis DB. Four versions of the double effect. J Med Philos . 1991;16:515-544.Crossref 27. Kamm F. The doctrine of double effect: reflections on theoretical and practical issues. J Med Philos . 1991;16:571-585.Crossref 28. Troug RD, Berde CB, Mitchell C, Grier HE. Barbiturates in the care of the terminally ill. N Engl J Med . 1992;327:1678-1681.Crossref 29. Meisel A. Legal myths about terminating life support. Arch Intern Med . 1991;151:1497-1502.Crossref 30. Miller DK, Coe RM, Hyers TM. Achieving consensus on withdrawing or withholding care for critically ill patients. J Gen Intern Med . 1992;7: 475-480.Crossref 31. American College of Physicians Ethics Manual, Third Edition. Ann Intern Med . 1992;117:947-960.Crossref 32. American Medical Association Council on Ethical and Judicial Affairs. Decisions near the end of life. JAMA . 1992;267:2229-2233.Crossref 33. Glantz L. Withholding and withdrawing treatment: the role of the criminal law. Law Med Health Care . 1987-1988;15:231-241. 34. Edwards MJ, Tolle SW. Disconnecting a ventilator at the request of a patient who knows he will then die: the doctor's anguish. Ann Intern Med . 1992;117:254-256.Crossref 35. Printz LA. Terminal dehydration: a compassionate treatment. Arch Intern Med . 1992;152:697-700.Crossref 36. Andrews M, Bell ER, Smith SA, Tischler JF, Veglia JM. Dehydration in terminally ill patients: is it appropriate palliative care? Postgrad Med . 1993; 93:201-208. 37. Sullivan RJ. Accepting death without artificial nutrition or hydration. J Gen Intern Med . 1993;8: 220-224.Crossref 38. Pearlman RA. Forgoing medical nutrition and hydration: an area for fine-tuning clinical skills. J Gen Intern Med . 1993;8:225-227.Crossref 39. Eddy DM. A conversation with my mother. JAMA . 1994;272:179-181.Crossref 40. Brock DW. Euthanasia. Hastings Cent Rep . 1993; 76:585-589. 41. Quill TE. The ambiguity of clinical intentions. N Engl J Med . 1993;329:1039-1040.Crossref 42. Quill TE, Cassel CK, Meier DE. Care of the hopelessly ill: potential clinical criteria for physician-assisted suicide. N Engl J Med . 1992;327:1380-1384.Crossref 43. Miller FG, Quill TE, Brody H, Fletcher JC, Gostin LO, Meier DE. Regulating physician-assisted death. N Engl J Med . 1994;331:119-123.Crossref 44. Baile WF, DiMaggio JR, Schapira DV, Janofsky JS. The request for assistance in dying: the need for psychiatric consultation. Cancer . 1993;72: 2786-2791.Crossref 45. Sullivan MD, Youngner SJ. Depression, competence and the right to refuse life-saving medical treatment. Am J Psychiatry . 1994;151:971-978. 46. Quill TE, Sussman B, Barold SS. Discontinuing an implantable cardioverter-defibrillator as a life-sustaining treatment. Am J Cardiol . 1994;74: 205-207.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

'You Promised Me I Wouldn't Die Like This!': A Bad Death as a Medical Emergency

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430120015002
Publisher site
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Abstract

Abstract DYING IS a time of vulnerability and potential. Ideally, it can be a time of spiritual healing and personal connection, but it can also be dominated by physical symptoms and fear of the future. Dying patients depend on their physicians, nurses, and social workers to approach them with skill, knowledge, caring, and compassion.1-5 The core commitment made by health care providers to their dying patients is nonabandonment—that no matter what happens, they will be there to work through problems together with the patient and family.6,7 There is a profound difference between facing an uncertain future with caring, skilled partners and facing it alone. One of our goals in working with the dying is to help them try to achieve a "good death."8-10 The meaning of this idealized concept may be highly individual, but there are likely to be some common objectives. The first is to die in References 1. Wanzer SH, Adelstein SJ, Cranford RE, et al. The physician's responsibility toward hopelessly ill patients. N Engl J Med . 1984;310:955-959.Crossref 2. Wanzer SH, Federman DD, Adelstein SJ, et al. The physician's responsibility toward hopelessly ill patients: a second look. N Engl J Med . 1989;320:844-849.Crossref 3. Seale CF. What happens in hospices: a review of research evidence. Soc Sci Med . 1989;28: 551-559.Crossref 4. Wallston KA, Burger C, Smith RA, Baugher RJ. Comparing the quality of death for hospice and non-hospice cancer patients. Med Care . 1988; 26:177-182.Crossref 5. Rhymes J. Hospice care in America. JAMA . 1990; 264:369-372.Crossref 6. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med . 1995; 122:368-374.Crossref 7. Cassel EJ. The Nature of Suffering and the Goals of Medicine . New York, NY: Oxford University Press Inc; 1991. 8. Aries P. The Hour of Our Death . New York, NY: Oxford University Press Inc; 1981. 9. Loxterkamp D. A good death is hard to find: preliminary reports of a hospice doctor. JAm Board Fam Pract . 1993;6:415-417. 10. Nuland SB. How We Die: Reflections on Life's Final Chapter . New York, NY: Alfred A Knopf Inc; 1994. 11. Quill TE. 'Doctor I want to die: will you help me?' JAMA . 1993;270:870-873.Crossref 12. Block SD, Billings JA. Patient requests to hasten death: evaluation and management in terminal care. Arch Intern Med . 1994;154:2039-2047.Crossref 13. Walsh TTD. Symptom control in patients with advanced cancer. Am J Hospice Palliat Care . 1992; 6:32-40.Crossref 14. Cohen MH, Johnston-Anderson A, Krasnow SH, Wadleigh RG. Treatment of intractable dyspnea: clinical and ethical issues. Cancer Invest . 1992; 10:317-321.Crossref 15. Cohen SR, Mount BM. Quality of life in terminal illness: defining and measuring subjective well-being in the dying. J Palliat Care . 1992;8:40-45. 16. Broadfield L. Evaluation of palliative care: current status and future directions. J Palliat Care . 1988;4:21-28. 17. Patt RB, ed. Cancer Pain . Philadelphia, Pa: JB Lippincott; 1993. 18. Solomon MZ, O'Donnell L, Jennings B, et al. Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health . 1993;83:14-23.Crossref 19. Quill TE. Death and Dignity: Making Choices and Taking Charge . New York, NY: WW Norton & Co Inc; 1993. 20. Kasting GA. The nonnecessity of euthanasia. In: Humber JM, Almeder RF, Kasting GA, eds. Physician-Assisted Death . Clifton, NJ: Humana Press; 1993:25-45. 21. Dobratz MC, Wade R, Herbst L, Ryndes T. Pain efficacy in home hospice patients: a longitudinal study. Cancer Nurs . 1991;14:20-26.Crossref 22. Saunders C. Pain and impending death. In: Wall PD, Melzack R, eds. Textbook of Pain . New York, NY: Churchill Livingstone Inc; 1984:472-478. 23. Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR. Symptom prevalence and control during cancer patients' last days of life. J Palliat Care . 1990;6:7-11. 24. Rachels J. Active and passive euthanasia. N Engl J Med . 1975;292:78-80.Crossref 25. Brody H. Causing, intending, and assisting death. J Clin Ethics . 1993:4:112-117. 26. Marquis DB. Four versions of the double effect. J Med Philos . 1991;16:515-544.Crossref 27. Kamm F. The doctrine of double effect: reflections on theoretical and practical issues. J Med Philos . 1991;16:571-585.Crossref 28. Troug RD, Berde CB, Mitchell C, Grier HE. Barbiturates in the care of the terminally ill. N Engl J Med . 1992;327:1678-1681.Crossref 29. Meisel A. Legal myths about terminating life support. Arch Intern Med . 1991;151:1497-1502.Crossref 30. Miller DK, Coe RM, Hyers TM. Achieving consensus on withdrawing or withholding care for critically ill patients. J Gen Intern Med . 1992;7: 475-480.Crossref 31. American College of Physicians Ethics Manual, Third Edition. Ann Intern Med . 1992;117:947-960.Crossref 32. American Medical Association Council on Ethical and Judicial Affairs. Decisions near the end of life. JAMA . 1992;267:2229-2233.Crossref 33. Glantz L. Withholding and withdrawing treatment: the role of the criminal law. Law Med Health Care . 1987-1988;15:231-241. 34. Edwards MJ, Tolle SW. Disconnecting a ventilator at the request of a patient who knows he will then die: the doctor's anguish. Ann Intern Med . 1992;117:254-256.Crossref 35. Printz LA. Terminal dehydration: a compassionate treatment. Arch Intern Med . 1992;152:697-700.Crossref 36. Andrews M, Bell ER, Smith SA, Tischler JF, Veglia JM. Dehydration in terminally ill patients: is it appropriate palliative care? Postgrad Med . 1993; 93:201-208. 37. Sullivan RJ. Accepting death without artificial nutrition or hydration. J Gen Intern Med . 1993;8: 220-224.Crossref 38. Pearlman RA. Forgoing medical nutrition and hydration: an area for fine-tuning clinical skills. J Gen Intern Med . 1993;8:225-227.Crossref 39. Eddy DM. A conversation with my mother. JAMA . 1994;272:179-181.Crossref 40. Brock DW. Euthanasia. Hastings Cent Rep . 1993; 76:585-589. 41. Quill TE. The ambiguity of clinical intentions. N Engl J Med . 1993;329:1039-1040.Crossref 42. Quill TE, Cassel CK, Meier DE. Care of the hopelessly ill: potential clinical criteria for physician-assisted suicide. N Engl J Med . 1992;327:1380-1384.Crossref 43. Miller FG, Quill TE, Brody H, Fletcher JC, Gostin LO, Meier DE. Regulating physician-assisted death. N Engl J Med . 1994;331:119-123.Crossref 44. Baile WF, DiMaggio JR, Schapira DV, Janofsky JS. The request for assistance in dying: the need for psychiatric consultation. Cancer . 1993;72: 2786-2791.Crossref 45. Sullivan MD, Youngner SJ. Depression, competence and the right to refuse life-saving medical treatment. Am J Psychiatry . 1994;151:971-978. 46. Quill TE, Sussman B, Barold SS. Discontinuing an implantable cardioverter-defibrillator as a life-sustaining treatment. Am J Cardiol . 1994;74: 205-207.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 26, 1995

References