User:Ssofeso/sandbox


 * Palliative sedation
 * Pregnancy test
 * Esophageal atresia

Palliative Sedation
My Sources:


 * 1) https://doi.org/10.1016/0885-3924(96)00046-2 (intermittent Sedation)
 * 2) https://dx.doi.org/10.4065%2Fmcp.2010.0201 (Ethical Decision Making with End of Life Care)
 * 3) https://hekint.org/2017/01/30/the-us-hospice-movement-redressing-modern-medicine/ (Hospice Care Movement)
 * 4) https://www.nahc.org/consumers-information/november-is-home-care-hospice-month/ (National Association for Home and Hospice Care)
 * 5) https://www.hospicewr.org/news-and-media/Documents/History-of-the-Hospice-Movement-new-logo-fonts.pdf (Hospice)
 * 6) https://www.nhpco.org/hospice-care-overview/history-of-hospice/ (History of Hospice)
 * 1) https://www.nhpco.org/hospice-care-overview/history-of-hospice/ (History of Hospice)

My Edits:


 * Alternative care methods used prior to palliative sedation (TS)


 * Add more information on the "hospice care movement" and expand on history of the movement, as well as the history of how palliative sedation came to be (TS)
 * Ethical Decision Making

Introduction
Palliative sedation should not be confused with Physician-assisted suicide, which is only legal in 10 jurisdictions, or euthanasia, which is an illegal practice.

Sedation v. Euthanasia
The primary difference between palliative sedation, relief of severe pain and symptoms, and euthanasia, the intentional ending of a patient's life, is both their intent and their outcome. In palliative sedation, the intended goal is to provide the patient some relief of their suffering through the use benzodiazapenes and other agents which inadvertently may increase the risk of death. Studies have been conducted however, that risk of death through palliative sedation is much lower than earlier perceived. This has raised the argument that palliative sedation does not cause or hasten death and that a patient's death following palliative sedation is more likely to be due to their disease - the measure of success of palliative sedation remains relief of a patient's symptoms until their end of life. On the other hand, euthanasia is performed with the intent to permanently relieve the patient of their pain through death - the measure of success being the patient's death.

Physician-Assisted Suicide
As of 2020, Assisted suicide in the United States, otherwise known as medical aid in dying, is legal in ten jurisdictions (California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, and Washington.

Continuous v. Intermittent Palliative Sedation
Palliative sedation can be administered continuously, until the patient's death, or intermittently, with the intention to discontinue the sedation at an agreed upon time. Although not as common, intermittent sedation allows family members of the patient to gradually come to terms with their grief and while still relieving the patient of their pain. During intermittent palliative sedation, the patient is still able to communicate with their family members. Intermittent sedation is recommended for use prior to continuous infusion to provide patient with some relief while still maintaining interactive function.

** Opening Section - add something about the legality compared to PAS and Euthanasia

U.S. Hospice Care Movement
The Hospice Care Movement began in the United States during the 1960s and was influenced heavily on the model published by St. Christopher's Hospice of London located in Great Britain. Despite differing setting, services, and staffing, the U.S. hospice care movement still sought to maintain the goals and philosophy of St. Christopher's model which centered on symptom control to allow the patient to die with freedom, rather than attempting curative treatment. Hospice care emphasizes palliative, rather than curative, treatment to support patients during end-of-life care when all other alternatives have been exhausted. It differs vastly from other forms of healthcare because both the patient and the family are included in all decision-making and aims to treat the individual, not the disease.

The first Hospice in the United States, Connecticut Hospice, was founded by Florence Wald and opened in 1974. Supporters of the movement faced many challenges early on, the biggest being the lack of insurance coverage for hospice care services. Initiatives to increase public awareness of the movement were created to combat this obstacle and supply the movement with public funding in order to maintain their services. One of the greatest accomplishments made by the movement was in the inclusion of hospice care in services covered under Medicare in 1982. This victor prompted the creation of National Hospice Week by President Reagan to take place from November 7-14 as a form of recognition to the vital impact nurses and caregivers have on these patients and their families. Less than five decades after the fist hospice program began, we now see over 4,000 programs in place under the umbrella of a multi-billion dollar industry. The cumulative budget for hospice programs nationwide increased from 10 million in the late 1970s, to 2.8 billion dollars in 1995, and 10 billion in 2008.