ABSTRACT
BACKGROUND AND OBJECTIVES: The decriminalisation of euthanasia and assisted medical suicide has generated a continuous debate. The terminological confusion is one of the main difficulties in obtaining medical practice consensus. The objective of this study was to determine whether the terms of Euthanasia and physician assisted suicide are used with the same meaning by doctors in Extremadura (Spain). MATERIAL AND METHOD: A qualitative study was conducted using two focus groups in which doctors from different specialties who attended a large number of terminal patients participated. No other focus group was required due to saturation. The sessions were tape recorded and transcribed by two experts in qualitative methodology. Atlas.ti software was used for the analysis. We were advised by the "Health Care at the end of life" Group of the Organizacion Médica Colegial of Spain. RESULTS: Terminological confusion was verified in: 1) The mixture of etymological, functional and social concepts, 2) the term Passive Euthanasia, 3) the association between euthanasia and physician assisted suicide, 4) the confusion with the equivalent "wish to hasten death", and 5) the difficulty of differentiating sedation with Euthanasia. There was consensus on some aspects: a) Full voluntariness, b) the condition of terminal illness, and c) the condition of unbearable symptoms. CONCLUSIONS: Conceptual variability persists in relation to the concept of Euthanasia, and is particularly noticeable in the persistence of the concept of passive euthanasia. It would be desirable to achieve a common language to assign a precise meaning to these words to help doctors in their professional practice.
Subject(s)
Euthanasia , Qualitative Research , Suicide, Assisted , Humans , Physicians , SpainABSTRACT
Objetivos: analizar los factores etiológicos de la disnea en una población atendida por un Equipo de Cuidados Paliativos (ECP) de ámbito de actuación mixta (hospitalario y domiciliario). Metodología: estudio longitudinal retrospectivo de los pacientes seguidos por el ECP de Badajoz y que fueron éxitus en el año 2005. Se reclutaron 195 pacientes, y se registraron las siguientes variables: edad, sexo, presencia de disnea, enfermedad terminal, localización del cáncer, factores etiológicos de la disnea: a) cardiopulmonar: (directa/indirecta); b) enfermedad concomitante; y c) causas sistémicas, saturación basal de oxígeno (SatO2), niveles de hemoglobina (Hb), índice de Karnofsky. El análisis fue realizado con el paquete estadístico Stata9, empleándose modelos de regresión logística. Resultados: el 60% de los pacientes presentaron disnea. La edad media fue de 73 años, el 64% eran mujeres; la enfermedad oncológica representó el 88% de los casos, siendo el cáncer de pulmón (n = 39) la neoplasia más frecuente. El odds de presentar disnea en los pacientes con afectación cardiopulmonar directa (1) e indirecta (2), era superior a aquellos que no referían disnea (OR1 = 0,1 OR2 = 0,05, p = 0,0001). El odds de la etiología sistémica fue > al 50% en pacientes con disnea (p = 0,052). No se demostró una asociación significativa entre SatO2 baja y disnea (p = 0,12). Los niveles de Hb ( < 11 mg/dl) se asociaron con la presencia de disnea (OR = 0,09/p = 0,005). Conclusiones: la afectación cardiopulmonar fue el factor etiológico más frecuente. Parece existir una asociación entre la etiología sistémica y la disnea. Los pacientes con cifras inferiores de Hb, mostraron mayor probabilidad de padecer disnea
Objectives: to analyze the etiologic factors of dyspnea in a population treated by a palliative care support team with both in-hospital and home activities. Methodology: a retrospective longitudinal study of patients included in a palliative care program within Badajoz health area who died in 2005. In all, 195 patients were recruited and the following variables were studied: age, sex, % patients with dyspnea, type of terminal disease, cancer site, etiologic factors of dyspnea (1. Local heart and lung (direct/indirect). 2. Associated disease. 3. Systemic causes). Oxigen saturation, hemoglobin level, and Karnofsky index. The analysis was performed using the statistical Stata9 method and logistic regression models. Results: sixty percent of cases showed dyspnea. Mean age was 73 (64% women). Cancer represented 88% of all cases (lung cancer was most frequent). The odds of dyspnea in patients with cardiac and lung disease, both direct (1) and indirect (2), were higher than in patients without that etiology (OR1 = 0.1 OR2 = 0.05, p = 0.0001). The odds of systemic causes were > 50% in patients with dyspnea (p = 0.052). The association was not statistically significant between oxygen saturation and dyspnea (p = 0.12). Hemoglobin levels were statistically associated with dyspnea (OR: 0.09/p = 0.005). Conclusions: the presence of cardiac and lung disease was the most prevalent etiology. Systemic causes were also associated with dyspnea. Patients with lower hemoglobin levels were more likely to suffer from dyspnea
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Dyspnea/epidemiology , Terminally Ill/statistics & numerical data , Palliative Care/statistics & numerical data , Longitudinal Studies , Retrospective Studies , Dyspnea/etiology , Pulmonary Heart Disease/complications , Lung Neoplasms/complicationsABSTRACT
La profilaxis intravesical con mitomicinaC (MMC) para la prevención de recurrencias del cáncer de vejiga , ha demostrado ser un tratamiento efectivo con pocos efectos secundarios. Sólo dos casos de toxicidad pulmonar después de la instilación endovesical de MMC han sido descritos en la literatura. Presentamos un paciente de 65 años que desarrolló una sarcoidosis pulmonar tras la administración intravesical de MMC. Esta asociación no había sido descrito hasta el momento actual.Asímismo se discuten las características clínicas y la patogenia de esta enfermedad pulmonar (AU)
Subject(s)
Aged , Male , Humans , Mitomycin , Sarcoidosis, Pulmonary , Antibiotics, Antineoplastic , Administration, Intravesical , Urinary Bladder NeoplasmsABSTRACT
Intravesical prophylaxis against recurrence of urinary bladder carcinomas using mitomycin C (MMC) has proved to be and effective treatment with few side effects. Previously only two cases of lung toxicity after instillation of MMC into the urinary bladder has been described. We report a 65-year-old man in whom lung sarcoidosis occurred after intravesical administration of MMC. This association has not been reported to date. The clinical picture and the pathogenesis of this lung disease are discussed.
