When it came to offering medical interventions to severely ill patients with no hope of recovery, my father had a fiercely strong opinion: They were inappropriate. For decades as an infectious diseases specialist, he had been asked to treat infections in dying patients. Whenever possible, he said no.
But when I approached my dad, who had developed end-stage Parkinson's disease, to ask what his end-of-life wishes were, he indicated a desire for aggressive measures.
Bioethicists have long debated the issue of "precommitment." Which wishes are more valid — ones that someone indicates in advance or those expressed during serious illness? My father's case provided a vivid case study of this issue.
A main reason that my father had entered the field of infectious diseases in the 1960s was medicine's new ability to treat severe infections. What was then the fairly recent discovery of antimicrobial agents like penicillin and streptomycin meant that endocarditis, tuberculosis and other previously untreatable infections could now be cured.
But as my dad's career progressed, his consults were as often as not on gravely ill patients who had experienced infection after infection and were getting worse, not better, even if a particular infection could be treated. Typically, these patients lived in nursing homes. Many had dementia. Some required permanent feeding and breathing tubes. Others had terminal cancer. One of his consults, I learned through reading his journals, had an "absolutely rampaging lymphoma" and was "obviously terminal and slipping rapidly," but her primary doctor wanted to treat yet another infection.
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http://opinionator.blogs.nytimes.com/2015/04/08/overruling-my-father/?
Thursday, April 9, 2015
Sunday, April 5, 2015
Antidepressants Aren't Taken By The Depressed; Majority Of Users Have No Disorder - Medical Daily
Depression's increase in the U.S. has been persisting for years, and it's going on decades. And while the increase in antidepressant use has followed a predictably similar path, not all cases can be explained by the parallel rise in disease. Many people, in fact, take antidepressants regardless of a diagnosis.
A new study published in The Journal of Clinical Psychiatry reports some 69 percent of people taking selective serotonin reuptake inhibitors (SSRIs), the primary type of antidepressants, have never suffered from major depressive disorder (MDD). Perhaps worse, 38 percent have never in their lifetime met the criteria for MDD, obsessive compulsive disorder, panic disorder, social phobia, or generalized anxiety disorder, yet still take the pills that accompany them.
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The Center for Patient Partnerships | University of Wisconsin
The Center for Patient Partnerships, affiliated with the University of Wisconsin Schools of Law, Medicine & Public Health, Nursing, and Pharmacy:
- Educates graduate students and working professionals in health advocacy;
- Provides free advocacy services to anyone with a serious or life-threatening illness, regardless of income or residence;
- Works to strengthen the field of health advocacy through research on advocacy's impact and promotion of best practices; and
- Enhances the capacity of patients to influence health policy and the responsiveness of the health care system to consumers' experiences.
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