Media Watch 528

Attached is the current edition of Media Watch (#528).

Of special interest in the current issue of the weekly report:
 

Advanced care planning: Pearls, perils, pitfalls, and promises

JOURNAL OF ONCOLOGY PRACTICE | Online – 28 August 2017 – With the passing of the Patient Self-Determination Act of 1990, the U.S. government put into place a mechanism to assess routinely whether patients have a living will or advance directive (AD). Despite the 27 years that have passed since the Act’s inception, there remain many challenges in how providers and patients discuss and implement end-of-life plans. Critics have consistently raised concerns that ADs are “fundamentally flawed (as they) presuppose more control over future care than is realistic.” Efforts at improving advance care planning (ACP) processes ... have sprung forth from concerns ... that “advance care planning ought to be the preparation of patients and surrogates to participate with clinicians in making the best possible in-the-moment medical decisions,” with less focus on the presence or absence of the document itself. Part of the challenge with approaching ACP and completion of ADs is that the creation of such documents is a static process that attempts to represent a dynamic, living human being. Although the values of that human being may remain consistent over a lifetime, the health and medical condition of that person often is not stable. Recent consensus panels have attempted to define more clearly what ACP actually is to better implement and measure its impact on outcomes; in addition, more succinct tools to validate ACP engagement behaviors have been recently tested. 

Does the distinctiveness of palliative care research require distinct ethical guidelines?

 

EUROPEAN JOURNAL OF BIOETHICS, 2017;8(15):31-57. Palliative and end-of-life care (EoLC) is changing, becoming more widespread and improving for patients. Yet, the current literature in the field suggests that the evidence for palliative and EoLC is somewhat limited. Research on treatment decisions, family care, and advance directions are just a few of the areas that need rigorous research efforts. Palliative care (PC) research is essential in order to continue providing effective treatments to those suffering in the last stages of life. Indeed, the goal of good PC research is to relieve suffering and to improve quality of life. Similar to any other field, PC programs must develop on a research base, and patient care will suffer if it is not backed by sound research. However, weighted against this need are some who maintain that the ethical and practical challenges of PC research are unique and insurmountable. This analysis considers if distinct ethical guidelines are needed for PC research.