Palliative extubation: obstacles, challenges and solutions

Life support withdrawal can be a challenging decision, but it should be considered as an option when death is inevitable or recovery to an acceptable quality of life is not possible. The process is beset by obstacles that must be overcome to finally offer patients comfort and a peaceful death.In this article, we offer a series of tools that seek to solve the challenges of palliative extubation, as well as a protocol that could facilitate the decision to withdraw life support, making palliative extubation an alternative to consider instead of artificially prolonging life at the expense of unacceptable human and economic costs.

'EUTHANASIA': AN ACT OF PERFORMANCE UNDER THE PURVIEW OF ETHICAL AND CONSTITUTIONAL ASPECTS

'Euthanasia' is the most debatable issue and has been a burning topic all over the world. The word 'Euthanasia' has been derived from Greek word 'Eu' means 'goodly' or 'well' and 'Thanatos' means 'death'. The lexicographical meaning of the word 'Euthanasia' is 'mercy killing' in which the intentional termination of the life of a terminally ill person is carried out by the assistance of another person. It is a process of carrying out a gentle and easy death of a terminally ill person when his death is desired to free him from his terribly painful life. 'Euthanasia' generally can happen in two ways – i. Passive Euthanasia and ii. Active Euthanasia. In Passive Euthanasia, the treating doctors withdraw life-support machines or withhold any further treatment to shorten the life of a dying person. In Active Euthanasia, the treating doctors apply overdose of painkillers or some other medications to quicken the death of a dying person. Some countries have legalized passive and some have legalized active euthanasia under certain legal guidelines. In this article, the subject of euthanasia has primarily been discussed from the perspective of its righteousness under the constitutional laws and its enshrinement. I also intended for a debate on the preference of active euthanasia over the passive euthanasia for quickening the death of a terminally ill person.

Severe ischaemic gangrene of scalp in an extreme preterm: a fatal case of combined aetiology

A 24+5-week preterm neonate with a severe scalp lesion was admitted to the neonatal intensive care unit (NICU) after caesarean section due to maternal chorioamnionitis (MC). An Arabin pessary had been inserted in addition to a previous cervical cerclage due to cervix insufficiency at 21+5 weeks of pregnancy (wp). At 23+5 wp, preterm rupture of membranes was evidenced. Both devices were kept to provide fetal viability. On 24+4 wp, she developed MC. Urgent caesarean section was performed. Transvaginal manual manipulation was required during the procedure. On NICU, she presented severe shock which required high-dose vasopressors and blood products. Following surgical repair, a bilateral grade IV intracranial haemorrhage was evidenced. Subsequently, it was agreed to withdraw life support. We hypothesise that MC and local infection could have acted as predisposing factors, with the presence of a pessary in the setting causing uterine contractions and its manipulation acting as a precipitating factor.

The Necessity of a Court Approval in Civil Proceedings on the Withdrawal of Life-Supporting Treatment for Terminally Ill Patients

The paper presents a comparative analysis of the positions of the courts in respect with the necessity of a court’s authorization to terminate life-support. Some courts hold that it is mandatory in any case, while the other reduce the role of the tribunals only to disputes arising from the decision to withdraw life-support.

Individualism and the Decision to Withdraw Life Support

The 1996 Health Care Consent Act of Ontario (Canada) is a law that regulates medical decision making. Therefore, it also gives indications on how end of life decisions should be made. The goal of the law was to ensure and protect patient’s autonomy and avoid medical paternalism, especially at the end of life. Throughout this article, I would like to argue that one of the consequences of the 1996 Health Care Consent Act of Ontario is to promote individualism. Therefore, this law makes it improbable to attain a shared decision model. More specifically, the way the 1996 Health Care Consent Act is currently written, a proxy is assigned as a decision-maker for someone who is deemed incompetent. However, it also ensures that the proxy will be the only one with the burden of that decision. This argument will be supported by providing a qualitative description of three cases that I have encountered during my six-month fieldwork in the Intensive Care Unit (ICU) of a hospital located in Ontario. This paper offers a reflection upon the consequences of using an alternative decision maker (proxy) to withdraw life support.

Supportive and End-of-Life Care in the Pediatric Intensive Care Unit

Providing supportive end-of-life care is an essential component of critical care. Intensivists require excellent communication skills to convey painful information in a compassionate manner and to assist families in making difficult decisions. Both aggressive life-supporting treatment and care following a decision to withdraw or withhold life-support require attention to providing adequate comfort care, including relief of pain, anxiety, delirium, agitation, nausea, and other gastrointestinal complaints. Understanding the use of a variety of drugs, including their interactions and side effects, as well as nonpharmacological therapies, is essential. Following a decision to withdraw life support, intensivists should develop a plan that is clear to other care providers and families, minimizes further interventions, and provides as much privacy as possible. After a child dies, numerous tasks must be completed; most important among them are offering parents an opportunity for follow-up support and giving involved staff members time to gather their thoughts and feelings.