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The living will in intensive care
Lamačová, Eva ; Prošková, Eva (advisor) ; Mellanová, Alena (referee)
v anglickém jazyce: The aim of the thesis is to provide description of nursing and medical aspects and offer ethical and legal context concerning the issue of living will. The body of the thesis is divided into theoretical section and practical section. The theoretical section deals with the issue of living will from the nursing and medical point of view with characterization of several serious conditions in intensive care such as apalic syndrome, terminal state etc. The chapter on legal aspects of living will defines the term 'lege artis', 'do not resuscitate - DNR', and characterizes the matter of decision making in the case of serious and terminal states. The chapter on ethical perspective discusses the process of dying and the Christian point of view on the issue of dying. The practical section processes the results of a survey based on 104 non-professional respondents and their replies to a provided questionnaire. The research section analyzes the level of knowledge which non-professional population has of the issue of living will. The closing discussion evaluates the confirmation of established hypotheses and provides practical suggestions. Keywords: living will, dying, ethic, resuscitation, terminal state.
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Ethical aspects of decisions made about resuscitation of patients in the terminal phase of illness in prehospital care
UHER, Lukáš
One of the three contraindications to initiation of cardiopulmonary resuscitation is a condition where the patient is in the terminal stage of the disease. (Bydžovský, 2008) The patient's terminal condition of incurable disease must be diagnosed by a doctor, not a paramedic or other health professional. (Sláma, 2009) The paramedic can (...) initiate and perform cardiopulmonary resuscitation. (Decree 55/2011 Coll., §17, letter. B) In an atmosphere where over-optimistic presentation of resuscitation protocol outcomes is growing, many people believe that it is the only orrect procedure for circulatory arrest regardless of life stage or terminal conditions. This increases the pressure put on the rescuers and doctors in pre-hospital emergency care by loved ones and family members of victims of sudden circulatory arrest. A paramedic and a doctor may respond the fear of legal challenges for failure to provide heroic care by actually begining resuscitation on patients with end-stage disease, but with less emphasis on the frequency and depth of compression of the sternum against their knowledge and beliefs. This phenomenon is called "hollywood resuscitation." (Sláma, 2009) The purpose of this thesis is to outline the ethical issues of resuscitation on patients in the terminal phase of illness as perceived by emergency workers. The research question that I deal with is, ?How do emergency medical rescue service staff access the decision to resuscitate terminally ill patients with particular regard to the expectations of family members?? The introduction introduces the reader with the nature of the paramedic profession, the importance of resuscitation and my relationship to the topic. In the theoretical part I define terms such as emergency medical service, resuscitation and its indications and contraindications, medical law and terminal condition. To get the results I used qualitative research that I realized at Emergency Medical Service South Moravian Region. I asked ten basic questions. The research group consists of two male doctors, four female doctors and seven paramedics. The interviews show that the notion of hollywood resuscitation is not known, but resuscitation at the interface of ethics and justice is experienced by all. Four paramedics rate their actions as unethical, this leaves them with the feeling of disapointment in themselves and their profession. They feel forced into this bind by the legislation. For the other three paramedics ethics at the place of the event were either do not percieve or they transfered esponsibility to the doctor by calling him. All of these doctors were fully qualified and most of them have not launched the resuscitation against their ethical beliefs. Some doctors avoid the issue by speaking with sensitivity to the family, others by solving the patient's current difficulties and they get the general information about him later. To improve this situation by contributing quality education to families in the facility where the patient is monitored for his primary diagnosis. Another solution could be specific document outlining end of life choices as desired by the patient or card on which ?Do Not Resuscitate? direction is clearly given. According to these specific documents pre-event direction is given that will direct amendment the standard procedure for emergency medical services. The rescue workers will feel greater legal certainty. This final designation document solution will increase paramedic´s competences.
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Care for the Dying in Hospice Facilities
PTÁČEK, Jan
This Thesis deals with the issue of illness and dying, and the care for the dying in different hospice facilities. In describes typical features of palliative medicine, it´s practical use in hospices and also the lack thereof in current Czech Medicine. The legislative side of this issue is discussed in this thesis as well.
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