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Age and life-sustaining treatment. Attitudes of intensive care unit professionals.

https://arctichealth.org/en/permalink/ahliterature211159
Source
Acta Anaesthesiol Scand. 1996 Sep;40(8 Pt 1):904-8
Publication Type
Article
Date
Sep-1996
Author
G. Melltorp
T. Nilstun
Author Affiliation
Department of Anaesthesiology, University Hospital MAS, Malmö, Sweden.
Source
Acta Anaesthesiol Scand. 1996 Sep;40(8 Pt 1):904-8
Date
Sep-1996
Language
English
Publication Type
Article
Keywords
Advance Directives
Age Factors
Attitude of Health Personnel
Euthanasia, Passive - psychology
Humans
Intensive Care Units
Life Support Care - psychology
Medical Staff, Hospital - psychology
Questionnaires
Sweden
Abstract
In Sweden, the official policy is that life-sustaining treatment should not be denied because of chronological age. This policy is also emphasised in a recent official report on priority setting in health care. But is this policy accepted among health care professionals? Do they consider chronological age relevant when decisions to forgo life-sustaining treatment are to be made?
Questionnaire survey to physicians, registered nurses and enrolled nurses at the Intensive Care Unit, University Hospital MAS, Malmö, Sweden.
More than 65% of the respondents were of the opinion that chronological age per se influenced decisions about life-sustaining treatment. Fewer, a little more than 40%, answered that it would make a difference to their own judgment about life-sustaining treatment whether the patient is 25 or 75 years old. The respondents were also confronted with 10 different factors characterising patients in need of life-sustaining treatment. According to a majority, advance directive, decision-making capacity, and chronological age should be taken into consideration in these situations.
The results indicate that chronological age is used as a criterion when decisions to forgo life-sustaining treatment are to be made in the ICU. Many health care professionals also believe that chronological age should be used as a criterion. This is clearly discordant with the official policy in Sweden and other countries, which is that age-based rationing is never justified.
PubMed ID
8908226 View in PubMed
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[An inquiry among medical students. No to legalization of euthanasia, but yes to dropped charges or remission of sentence].

https://arctichealth.org/en/permalink/ahliterature193453
Source
Lakartidningen. 2001 Aug 8;98(32-33):3417-8
Publication Type
Article
Date
Aug-8-2001
Author
T. Nilstun
Author Affiliation
Enheten för medicinsk etik, Lunds universitet. Tore.Nilstun@medetik.lu.se
Source
Lakartidningen. 2001 Aug 8;98(32-33):3417-8
Date
Aug-8-2001
Language
Swedish
Publication Type
Article
Keywords
Attitude to Death
Euthanasia - legislation & jurisprudence - psychology
Humans
Questionnaires
Students, Medical - psychology
Sweden
Abstract
In a questionnaire to medical students in Sweden, only 6 out of 135 answered that they wanted voluntary active euthanasia to be legalized. However, most of the students were of the opinion that the charges brought against the physician could be withdrawn pending assessment by a public prosecutor (55), or alternatively, that remission of sentence could be granted pending assessment by a court (45). A somewhat smaller group (26) answered that prison corresponding to the sentence for manslaughter was reasonable. Only 3 students considered voluntary active euthanasia to be murder. Legal monitoring of each case of active euthanasia was very important to these medical students, but many answered that under specific conditions there should be no punishment.
Notes
Comment In: Lakartidningen. 2001 Sep 5;98(36):383911586820
PubMed ID
11526661 View in PubMed
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[Compulsory isolation of HIV-positive persons--why is it so difficult to agree?]

https://arctichealth.org/en/permalink/ahliterature8241
Source
Lakartidningen. 1991 Jul 24;88(30-31):2540-2
Publication Type
Article
Date
Jul-24-1991
Author
T. Nilstun
Author Affiliation
Filosofiska institutionen, Lunds universitet.
Source
Lakartidningen. 1991 Jul 24;88(30-31):2540-2
Date
Jul-24-1991
Language
Swedish
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - psychology - transmission
Ethics, Medical
HIV Seropositivity - psychology - transmission
Humans
Legislation, Medical
Patient Isolation - psychology
Risk factors
Sweden
PubMed ID
1865724 View in PubMed
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["Concealed" decisions to restrain from cardiopulmonary resuscitation. Unified symbols and plain language should be required].

https://arctichealth.org/en/permalink/ahliterature212670
Source
Lakartidningen. 1996 Feb 7;93(6):477-80
Publication Type
Article
Date
Feb-7-1996
Author
T. Nilstun
R. Löfmark
Author Affiliation
Lunds universitet.
Source
Lakartidningen. 1996 Feb 7;93(6):477-80
Date
Feb-7-1996
Language
Swedish
Publication Type
Article
Keywords
Cardiopulmonary Resuscitation
Documentation
Family - psychology
Humans
Medical Records
Patient Advocacy
Questionnaires
Resuscitation Orders
Sweden
PubMed ID
8637327 View in PubMed
Less detail

[Conflicting values in evaluation of psychiatric care--a review].

https://arctichealth.org/en/permalink/ahliterature197048
Source
Lakartidningen. 2000 Aug 30;97(35):3758-61
Publication Type
Article
Date
Aug-30-2000
Author
T. Nilstun
L. Jacobsson
C G Westrin
S. Thelander
Author Affiliation
Institutionen för medicinsk etik, Lunds universitet. Tore.Nilstun@medetik.lu.se
Source
Lakartidningen. 2000 Aug 30;97(35):3758-61
Date
Aug-30-2000
Language
Swedish
Publication Type
Article
Keywords
Commitment of Mentally Ill
Ethics, Medical
Evaluation Studies as Topic
Humans
Informed consent
Mental Disorders - diagnosis - therapy
Mental Health Services - standards
Patient Advocacy
Psychiatry - standards
Sweden
Abstract
Greater understanding is needed regarding psychiatric disorders and their causes, as well as the effects of psychiatric care. Ethical issues ought to be discussed in terms of both the choice of questions and to the ways in which data are collected. So far, most evaluations of psychiatric care have focused on medical utility, while issues of autonomy and impartiality are sorely lacking. An important challenge for the future is therefore to support the evolution of the search for knowledge into a multidisciplinary activity in which values concerning autonomy and impartiality are also incorporated.
PubMed ID
11016231 View in PubMed
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Deciding not to resuscitate. Responsibilities of physicians and nurses--a proposal.

https://arctichealth.org/en/permalink/ahliterature209733
Source
Scand J Caring Sci. 1997;11(4):207-11
Publication Type
Article
Date
1997
Author
R. Löfmark
T. Nilstun
Author Affiliation
Department of Medicine, Länssjukhuset, Gävle, Sweden.
Source
Scand J Caring Sci. 1997;11(4):207-11
Date
1997
Language
English
Publication Type
Article
Keywords
Decision Making
Humans
Interprofessional Relations
Job Description
Medical Staff, Hospital - psychology
Nursing Staff, Hospital - psychology
Professional Competence
Questionnaires
Resuscitation Orders
Social Responsibility
Sweden
Abstract
After discussing the decision with the staff, physicians should investigate the conditions for a do-not-resuscitate (DNR) order, make the decision, and inform the patient and the family. But, according to the present and other studies, they are not taking the full responsibility for these tasks. Nurses are supposed to participate in the discussions with the physicians prior to a DNR decision, but not to make the decision or to inform the patient and the family. Physicians and nurses have different opinions about their legitimate roles when DNR orders are initiated and made. However, 8% of the nurses in the present study state that they have made a DNR decision and 37% declare that the nurse should do so. We propose a model where the skills of the responsible physician (to make the diagnosis and prognosis) and the skills of the responsible nurse (to communicate with the patients by virtue of their close relationship) are combined. Accordingly, future guidelines should stress the joint responsibility of physicians and nurses to investigate the conditions precedent for a DNR order, to make the DNR decision, and to inform the patients and the family.
PubMed ID
9505727 View in PubMed
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Decisions to forego life-sustaining treatment and the duty of documentation.

https://arctichealth.org/en/permalink/ahliterature34624
Source
Intensive Care Med. 1996 Oct;22(10):1015-9
Publication Type
Article
Date
Oct-1996
Author
G. Melltorp
T. Nilstun
Author Affiliation
Department of Anaesthesiology, Central Hospital, Växjö, Sweden.
Source
Intensive Care Med. 1996 Oct;22(10):1015-9
Date
Oct-1996
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Decision Making
Documentation
Female
Forms and Records Control - legislation & jurisprudence
Humans
Infant
Infant, Newborn
Intensive Care Units - organization & administration
Life Support Care
Male
Medical Futility
Medical Records
Middle Aged
Physician's Practice Patterns
Prognosis
Resuscitation Orders
Sweden
Abstract
OBJECTIVE: To study the current practice of documenting decisions to forego life-sustaining treatment in an intensive care unit (ICU), using the Swedish Medical Records Act as a frame of reference. SETTING: The ICU at Malmoe General Hospital, Sweden. MATERIALS: The medical records of the first 600 cases treated in the ICU in 1992. METHODS: Analysis of documents and informal observational procedures. RESULTS: Decisions to forego life-sustaining treatment were documented in the medical records of 34 patients, 17 of whom died in the ICU. In many cases, the treatment is specified, but often it is only rather vaguely described. The main reason for foregoing treatment is poor prognosis. There is no indication that the decisions had been discussed with the patients. In 18 of the 34 medical records, there are notes indicating that relatives were informed about the decision. Notes in most of the 34 medical records imply that joint deliberation took place between the anaesthesiologists in the ICU and the other physician(s) responsible for the treatment of the patient. CONCLUSION: The medical records give a fairly accurate picture of the frequency with which such decisions are made at this particular ICU, although the number might be somewhat underestimated. However, the content of the documentation is rather scanty and does not fully satisfy the requirements of the Swedish Medical Records Act. Further studies are needed to warrant any generalization.
Notes
Comment In: Intensive Care Med. 1996 Oct;22(10):1003-58923060
PubMed ID
8923063 View in PubMed
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The difference between withholding and withdrawing life-sustaining treatment.

https://arctichealth.org/en/permalink/ahliterature206550
Source
Intensive Care Med. 1997 Dec;23(12):1264-7
Publication Type
Article
Date
Dec-1997
Author
G. Melltorp
T. Nilstun
Author Affiliation
Department of Anaesthesiology, University Hospital MAS, Malmö, Sweden.
Source
Intensive Care Med. 1997 Dec;23(12):1264-7
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Ethics, Medical
Health Personnel - psychology
Humans
Life Support Care - economics - standards
Practice Guidelines as Topic
Questionnaires
Sweden
Treatment Outcome
Abstract
First, to present the position on the distinction between withholding and withdrawing life-sustaining treatment as expressed in guidelines and examine its relation to the attitudes of health care professionals. Second, to examine the possible ethical justification of this distinction.
Critical analysis of guidelines on life-sustaining treatment and questionnaire administered to 148 health care professionals--physicians and nurses at the intensive care unit (ICU), University Hospital MAS, Malmö, Sweden.
In contrast to the guidelines, which emphasize that there is no ethical difference between withholding and withdrawing life-sustaining treatment, not less than 50 per cent of the professionals in the ICU were of the opinion that there is an ethical difference. All attempts to justify this difference with reference to an inherent distinction between withholding and withdrawing seem to be controversial.
We recommend a change in emphasis in professional guidelines. Such guidelines should avoid the controversial issue about the possible inherent ethical difference between withholding and withdrawing life-sustaining treatment. What should be underlined is that the particular situation and the consequences of withholding as well as withdrawing life-sustaining treatment should always be taken into account.
PubMed ID
9470083 View in PubMed
Less detail

[Disagreement among physicians about active euthanasia. 245 answers from a Swedish questionnaire reflect uncertainty].

https://arctichealth.org/en/permalink/ahliterature212159
Source
Lakartidningen. 1996 Apr 3;93(14):1350-1
Publication Type
Article
Date
Apr-3-1996
Author
T. Nilstun
G. Melltorp
R. Löfmark
P. Sjökvist
Author Affiliation
Lunds universitet.
Source
Lakartidningen. 1996 Apr 3;93(14):1350-1
Date
Apr-3-1996
Language
Swedish
Publication Type
Article
Keywords
Attitude of Health Personnel
Euthanasia
Humans
Physicians - psychology
Questionnaires
Sweden
PubMed ID
8656869 View in PubMed
Less detail

Do-not-resuscitate orders--should the patient be informed?

https://arctichealth.org/en/permalink/ahliterature208562
Source
J Intern Med. 1997 May;241(5):421-5
Publication Type
Article
Date
May-1997
Author
R. Löfmark
T. Nilstun
Author Affiliation
Department of Medicine, Länssjukhuset, Gävle, Sweden.
Source
J Intern Med. 1997 May;241(5):421-5
Date
May-1997
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cardiology
Ethics, Medical
Humans
Informed consent
Nurses - psychology
Patient Participation
Physicians - psychology
Practice Guidelines as Topic
Questionnaires
Resuscitation Orders
Sweden
Abstract
To analyse the ethical implications of informing patients about their do-not-resuscitate status (DNR).
Questionnaire.
Nationwide, 6 months after the publication of guidelines on DNR in 1994.
A 10% random sample of the members of the Swedish Cardiac Society. 104 physicians and 196 nurses.
To what extent are patients, physicians and nurses involved in decisions about DNR, and how should the ethical conflict involved in informing patients about their DNR status be described and analysed?
Of 73% responding, 84% of the physicians and 8% of the nurses had made a DNR decision. The decision was regarded as ethically right and well timed and it was discussed with 33% of the competent patients. Half of the respondents believed that DNR orders should be discussed with the competent patient. but still only one third of the patients are involved. The ethical conflict is analysed using the principles of autonomy and nonmaleficence as value premises.
Many physicians are still reluctant to find out what the patient wants. Being ignorant they risk harming the patient. It is recommended that information about DNR status should be given incrementally and that the attitudes of the old and chronically ill in-hospital patients are studied. Do they want to be informed, and if so, how and when do they want it to be done?
PubMed ID
9183311 View in PubMed
Less detail

32 records – page 1 of 4.