Friday, September 22, 2006

JAMA Trifecta: spirituality, kids, turning off oxygen; I'm going to Montreal

The latest JAMA has 3 articles to note:

A "Clinician's Corner" piece about spirituality and dying . It focuses on a case of conflict surrounding end of life decision making in which a patient believed God would cure him miraculously. The article is mostly a general overview of the topic; it's a good 'teaching file' article but I don't have much more to say about it.

A coda to their recent piece on sudden traumatic death in children .

A commentary on discontinuing oxygen therapy in the dying. It approaches oxygen therapy as any other life-prolonging medical treatment that can be discontinued, and addresses head on concerns with this, including that the decision may be motivated by a desire to stop all barriers to death. I was hoping the the commentary would spend more time attacking and discarding the 'burdensome' idea (that's it's ok to stop 'burdensome' medical interventions at the end of life). The commentary mentions this somewhat but not at length. (I've mentioned this on the blog before--using the rhetoric of 'it's ok to stop burdensome medical interventions at the end of life' implies...sort of...that it's not ok to stop non-burdensome interventions, or that we should continue medical interventions that aren't burdensome, etc. I find this confusing and missing the boat, and instead prefer to talk about what are the goals of care--what are we trying to accomplish and what sort of care, medical or otherwise, is the best way to accomplish it? If the goal is to provide someone with a peaceful, comfortable death then oxygen therapy may or may not be indicated depending on the situation, but the standard is whether or how likely is it to meet some goal-- not whether or not it's burdensome. Of course, a patient may, and many do, decline medical treatments specifically because of the burden it places on them; that is a patient's perogative.)

I'm going to the 16th International Congress on Care of the Terminally Ill in Montreal next week, so I probably won't post until the week after. If you're a Pallimed reader and see me, please say Hi.

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