Suchergebnisse

BackgroundThere is broad consensus within the disability field that the end‐of‐life care offered to people with intellectual disabilities should be of a quality consistent with that advocated by contemporary palliative care. In practice, however, various barriers are encountered when applying palliative care strategies to the end‐of‐life care of people with intellectual disabilities, particularly those in disability community living services.MethodsA mixed‐methods approach was used. Quantitative data were gathered through a survey of disability support staff working in government‐managed community living services in the Australian state of Victoria.These quantitative data informed the collection of qualitative data through focus groups and research interviews. A public health palliative care framework provided the basis for developing an organizational change model from the consolidated data.ResultsThere is a strong relationship between organizational structure and culture, and both influence end‐of‐life practice in community living services.Barriers to good practice arise from the differing attitudes of paid carers involved, and from uncoordinated approaches reflecting misaligned service systems in the disability and palliative care fields. Organizational reorientation is crucial to achieving sustainable change that will support healthy dying.ConclusionsEnd‐of‐life care requires the collaboration of disability and palliative care services, but for care to achieve palliative care goals, the collaboration must be led by disability services. We outline here an organizational model we have developed from public health principles to manage end‐of‐life care in community living services.

This article presents the findings of quantitative and qualitative research involving over 300 Australian health care chaplains concerning their involvement in patient and staff issues with regard to euthanasia. Approximately one quarter of chaplains (26.3%) indicated having been involved in patient / family euthanasia issues and one fifth of chaplains were involved in staff euthanasia issues. Forty-three (n = 43) chaplains consented to in-depth interviews about the nature of their involvement in euthanasia issues. It is noted that the important knowledge and tacit experience of those trained and practicing in pastoral care should be included when considering euthanasia issues and decisions.

Using personal insight and interpretation the authors summarise the results and discussion of the largest cross sectional empirical study of Australian Health Care Chaplains concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. The implications of this study concerning, health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and interpreted.