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Identifier 000353304
Title Βιοηθικά ζητήματα σε σχέση με τις υπηρεσίες φροντίδας υγείας σε ασθενείς τελικού σταδίου
Author Βασιλείου, Αικατερίνη Χ.
Thesis advisor Φιλαλήθης, Αναστάσιος
Reviewer Μολύβας, Γρηγόρης
Γκούνης, Κωνσταντίνος
Abstract The medical achievements and the development of medical technology are the common place of the fulfillment of expectations as far physicians, scientists and people-patients are concerned about the prolongation of life. However, this kind of treatment of health and life can’t be plausibly covered at the exceeding, since the existence of incurable diseases, which consists the biggest percentage of death causes in the contemporary world, shows that there is a need of a more careful and significant management of those cases. The common feature that characterizes the situations that are mentioned above, either they lead to a gradual impoverishment of human organism (cancer, renal failure, Alzheimer) either to sudden death (heart failure), is the fact that they are illnesses which bring patients into an irreversible condition, accepting and expecting the moment of their dying. In particular, “terminal patients5” are considered those patients that are in an irreversible or non curable condition, which might lead them to death, in a short time of period (one year) with or without medical intervention. As for the disease itself is considered the condition that is medically confirmed as non curable and irreversible, leading patients to death more or less in six months. On the base of all these facts, the current, national health systems, social and hospital policies have gradually started being differently organized in relation to the way of treatment of illness and patients’ ethical coverage6. In the past, as also these days of course, there was a focus on the “aggressive” medicine or treatment till the last moments of the patient. This had an equivalent, exhausting effect on the physical and mental state of the terminal ill people. The more increasing interaction and familiarization of public opinion with the medical facts and the gradual enforcement of patient’s role through his/her participation in the way of decision making, brought in the spotlight, apart 5 Margaret A. Drickamer, MD; Melinda A. Lee, MD; and Linda Ganzini, MD, 1997, “Practical Issues in Physician-Assisted Suicide”, Annals of Internal Medicine, 126(2), p. 148 6 Diane E. Meier, R. Sean Morrison, Christine K. Cassel, 1997, “Improving Palliative Care”, Annals of Internal Medicine”, p. 225-230 from the duties and the power of physician (according to the medical code of deontology), the power of the patients, too (based on safeguarded rights). In this way, it is clear that a patient shouldn’t be treated as a reflection or an expression of illness, but as an agent of will, desires and emotions. For this reason, it has been started emerging different types of care within the hospital frameworks which focus on the provision of health care to patients at the last stage of their lives (end-of-life care, terminal care). This new perspective is due to people’s desire, regardless of their cultural origins, having a “good”, “dignified” death. This request or wish is differently expressed by each person and it is always in relation to the region of the health care services provision during the end of life, as each hospital unit or medical team follows variant policies. For instance, in few hospitals physicians’ decisions that refer to terminal patients are based on tactics such as: life sustaining7, withdraw and withhold treatment8, CPRs (Cardio Pulmonary Resuscitations) or DNRs (Do Not Resuscitate), or even euthanasia or physician assisted suicide if the institutional and the legal system of a country permits it, e.g. Holland. The aim of this dissertation is to set a central speculation about the special and sensitive category of terminal patients who are traced into all the human societies, the corresponding services and structures for this group of people (end-of-life care, terminal care) in hospital (intensive care unit, palliative care, DNR, euthanasia or assisted suicide) and public policy level (hospice care, home care, supportive care) and finally, the bioethical issues that arouse in regard to the kind of choices that are made about the health care forms. As such could be considered the advocacy and the protection of the ethical values of patients, the distributive justice (social, political and financial factors), as far the way of health care provision and other social conditions are concerned, which influence the content of physicians and patients’ decisions in the way of conducting terminal care procedures. 7 Gerhild Becker, MD, MTh, Robert Sarhatic, Msc, Manfred Olschewski, Msc, Carola Xander, Msc, Felix Momm, MD, and Hubert E. Blum, MD, University Hospital Freiburg, 2007, “End-of-Life Care in Hospital: Current Practice and Potentials for Improvement”, Journal of Pain and Symptom Management, 33(6), p. 713 8 Charles L. Sprung, MD, Simon L. Cohen, MD, Peter Sjokvist, MD, Mario Baras, PhD, Hans-Henrik Bulow, MD, Seppo Hovilehto, MD, Didier Ledoux, MD, Anne Lippert, MD, Paulo Maia, MD, Dermot Phelan, MD, Wolfgang Schobersberger, MD, Elisabet Wennberg, MD, PhD, Tom Woodcock, MB, BS for the Ethicus Study Group, 2003, “End-of-Life Practices in European Intensive Care Units-The Ethicus Study”, JAMA, 290(6), p. 791
Physical description 88 σ. : πιν. ; 30 εκ.
Language Greek
Subject Attitude to Death
Bioethical Isuues
Decison Making
Ethics, Medical
Personal Autonomy
Quality of Life
Terminal Care ethics
Λήψη απόφασης
Πανεπιστήμιο Κρήτης. Τμήμα Βιολογίας Μεταπτυχιακές εργασίες.
Πανεπιστήμιο Κρήτης. Τμήμα Κοινωνιολογίας Μεταπτυχικές εργασίες.
Πανεπιστήμιο Κρήτης. Τμήμα Φιλοσοφικών και Κοινωνικών Σπουδών Μεταπτυχιακές εργασίες.
Ποιότητα ζωής
Προθανάτια φροντίδα Δεοντολογία
Στάση απέναντι στο θάνατο
Issue date 2009-12-14
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Notes Διατμηματικό πρόγραμμα μεταπτυχιακών σπουδών Βιοηθικής.
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