Palliative Sedation in Terminal Cancer Patients Admitted to Hospice or Home Care Programs: Does the Setting Matter? Results From a National Multicenter Observational Study.

CONTEXT: Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. OBJECTIVES: Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS. METHODS: About 38 HC/HS services in Italy participated in a multicenter observational longitudinal study. Consecutive adult cancer patients followed till death during a four-month period and undergoing PS were eligible. Symptom control and level of consciousness were registered every eight hours to death. RESULTS: About 4276 patients were screened, 2894 followed till death, and 531 (18%) underwent PS. PS rate was 15% in HC and 21% in HS (P < 0.001). Principal refractory symptoms were delirium (54%) and dyspnea (45%), respectively, more common in HC (P < 0.001) and HS (P = 0.03). Informed consent was not obtained in 72% of patients but achieved by 96% of families. Midazolam was the most used drug (94% HS vs. 75% HC; P < 0.001) mainly by continuous infusion (74% HC vs. 89% HS; P < 0.001). PS duration was less than 48 hours in 67% of patients. Hydration during PS was less frequent in HC (27% vs. 49%; P < 0.001). In the eight hours before death, consciousness level was unrousable to mild physical stimulation in 81% and symptom control complete in 89% of cases. CONCLUSION: Our results show feasibility of PS in HC and HS and suggest setting differences in rates, indications, and practice of PS, possibly related to patients' selection or care organization.

The attribution of intentionality: the role of skill and morality.

The present study contributes to the discussion on the different components which constitute the intentionality concept about an undesired side effect, focusing on the morality and the skill. Two hundred and forty participants were asked to read a brief story about a car accident, in which it was explained the motivation of the high speed and objective and subjective skill of the agent to drive the car, and to fill in six questions about intentionality, objective risk, mental representation of risk, risk acceptance and blameworthiness for the outcome. The principal results showed that when the motivation is morally negative, people judge the side effect more intentional, also because they make more severe judgments about risk and blameworthiness. Moreover, when people are objectively proficient to perform the action (objective skill) the side effect is considered less risky and intentional and, in the case of a negative outcome, they are judged less severely than if they have a poor ability. Finally, a self-assessment of low skill to make the action (subjective skill) leads people to assess higher risks and, consequently, more intentionality for the side effect. The results are discussed on the basis of the literature about some specific components that make up the intentionality concept.

The law of February 19th 2004, No. 40: Procreation and punishment

El 19 de febrero de 2004, el Parlamento de la República Italiana aprobó la Ley No. 40, en matería de "Procreación Médica Asistida". Esta ley fue adoptada por una gran mayoría de la cámara, que incluía tanto a parlamentarios católicos, como a no católicos, tiene como principal opositor a la Iglesia, la cual está en contra de cualquier forma de procreación artificial. A pesar de ello, no hay que olvidar que está ley establece númerosas limitaciones a la "Procreación Médica Asistida" que la hace singular en su materia; especialidades tales como la prohibición de concebir un ser humano utilizando el procedimiento de fertilización in vitro con el esperma obtenido fuera de los progenitores, con progenitores de una edad avanzada o una vez fallecido el donante. Por tanto, este artículo partiendo de la idea de que toda regulación de la "Procreación Asistida" debe hacerse desde una perspectiva racional, desgrana la ley estableciendo la importancia de que el legislador regule teniendo en cuenta los derechos personales constitucionales (dignidad humana) e incluya asímismo las sanciones puntivas dentro del marco de la ley penal moderna

The Parliament of the Italian Republic, on 19 February 2004, has approved Law no. 40 on Medically Assisted Procreation. This law was adopted by the majority of the members of the Chamber, including both catholic as well as non-catholic members. The main opposition comes from the Church, which is against any form of artificial procreation. In spite of this, we must not forget that this law sets numerous limitations to Medically Assisted Procreation, which makes it unique in the matter. Examples are the prohibition to conceive a human being using in vitro fertilisation with sperm that is not from the parents, or the prohibitions of having parents of an advanced age or using the sperm once the donor is dead. Therefore, this article is based on the idea that every regulation on Assisted Procreation must be done from a rational perspective. The article analyses section by section the law emphasizing the importance that the legislator has. Stating that the legislator must take into account the constitutional personal rights (human dignity) and must likewise include punitive sanctions within the framework of the modern penal law

The law of February 19th 2004, No. 40: Procreation and punishment

El 19 de febrero de 2004, el Parlamento de la República Italiana aprobó la Ley No. 40, en matería de "Procreación Médica Asistida". Esta ley fue adoptada por una gran mayoría de la cámara, que incluía tanto a parlamentarios católicos, como a no católicos, tiene como principal opositor a la Iglesia, la cual está en contra de cualquier forma de procreación artificial. A pesar de ello, no hay que olvidar que está ley establece númerosas limitaciones a la "Procreación Médica Asistida" que la hace singular en su materia; especialidades tales como la prohibición de concebir un ser humano utilizando el procedimiento de fertilización in vitro con el esperma obtenido fuera de los progenitores, con progenitores de una edad avanzada o una vez fallecido el donante. Por tanto, este artículo partiendo de la idea de que toda regulación de la "Procreación Asistida" debe hacerse desde una perspectiva racional, desgrana la ley estableciendo la importancia de que el legislador regule teniendo en cuenta los derechos personales constitucionales (dignidad humana) e incluya asímismo las sanciones puntivas dentro del marco de la ley penal moderna

The Parliament of the Italian Republic, on 19 February 2004, has approved Law no. 40 on Medically Assisted Procreation. This law was adopted by the majority of the members of the Chamber, including both catholic as well as non-catholic members. The main opposition comes from the Church, which is against any form of artificial procreation. In spite of this, we must not forget that this law sets numerous limitations to Medically Assisted Procreation, which makes it unique in the matter. Examples are the prohibition to conceive a human being using in vitro fertilisation with sperm that is not from the parents, or the prohibitions of having parents of an advanced age or using the sperm once the donor is dead. Therefore, this article is based on the idea that every regulation on Assisted Procreation must be done from a rational perspective. The article analyses section by section the law emphasizing the importance that the legislator has. Stating that the legislator must take into account the constitutional personal rights (human dignity) and must likewise include punitive sanctions within the framework of the modern penal law

The law of February 19th 2004, No. 40: procreation and punishment.

The Parliament of the Italian Republic, on 19 February 2004, has approved Law no. 40 on Medically Assisted Procreation. This law was adopted by the majority of the members of the Chamber, including both catholic as well as non-catholic members. The main opposition comes from the Church, which is against any form of artificial procreation. In spite of this, we must not forget that this law sets numerous limitations to Medically Assisted Procreation, which makes it unique in the matter. Examples are the prohibition to conceive a human being using in vitro fertilisation with sperm that is not from the parents, or the prohibitions of having parents of an advanced age or using the sperm once the donor is dead. Therefore, this article is based on the idea that every regulation on Assisted Procreation must be done from a rational perspective. The article analyses section by section the law emphasizing the importance that the legislator has. Stating that the legislator must take into account the constitutional personal rights (human dignity) and must likewise include punitive sanctions within the framework of the modern penal law.