Role Reversal

¹Medical Scientist Training Program, University of Minnesota, Minneapolis

JAMA. 2022;328(20):2013. doi:10.1001/jama.2022.20556

“Helmet, helmet!” squealed my daughter, excitedly. I followed behind as she ran to the back door, ready to start the day. The bike ride to her daycare center had become our shared morning ritual, a ritual that I had started long before she entered the world 16 months ago. The bike ride to the research laboratory or hospital had become one of the most cherished parts of my days. The ride gave me time to reflect on the day ahead and to be present. Now it is something that my daughter has come to love as much as I do.

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2022年11月25日

Comfort or Treat - Why Not Both?

Eugene Breen, MRCPI, MRCPsych, DGM, DCh| Mater Misericordiae University Hospital Dublin

我认为最大的问题是乔安决定go for comfort care. Music, lights and smiles ensue but what does it mean? Did JoAnne have a choice? She was in her 90s and had a stroke and interventions must be limited. The point being that in this case maybe a natural death was the only option. For many including some of my elderly friends this move from active treatment to comfort pathway was followed by a fairly swift death. Is this a reality-based "decision"? Who and on what grounds has terminal treatment been so carved into these categories? It surely should be questioned because it assumes authority and practice and teaching and respectability as a standard procedure in palliative care. I didn't say the words physician-assisted death or euthanasia but you have to think it's on the same spectrum. A happy release, a catharsis, a release from further discomfort and from life obviously could cause a momentary emotional uplift, but is it ethical to put vulnerable people in this "either-or" situation, treat or comfort? We are not ignoring the nuances of care in palliative care and the multidisciplinary inputs required - palliation, treatment, psychological and family/friend support and spiritual support. Comfort could well be the right decision for many with intractable incurable illness in their final stages, but for many more people treatment could mean multidisciplinary support and understanding of their fragile state and not putting them on the spot to make decisions they may not have the capacity to make or comprehend.

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Role Reversal

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