Suchergebnisse

Advance care planning is an essential part of the new NHS national programme on end of life care, aiming to improve the chances of 'a good death' by discussing and planning how this might be managed. This work helps readers explore a wide range of issues and practicalities in providing ACP for patients nearing the end of life.

Purpose – The purpose of this paper is to explore how manufacturers can develop automatic end-of-life processes facilitated by product design methods, e.g. design for disassembly, recycling and remanufacturing. Also to illustrate this kind of product and end-of-life process development while maintaining economic and environmental values. Here, the cases of toner cartridges and liquid crystal displays are the focus. Design/methodology/approach – The research methodology for this paper began with a literature study within the fields of design for automatic recycling and remanufacturing. It also includes the research performed at two different industrial companies using automation in their end-of-life processes. These companies were visited and interviewed several times, in order to understand their processes and what current problems they have in automation and product design. Findings – Design implications on the end-of-life have been explored, and in particular, three general product trends are in conflict with automatic disassembly: products are getting more complex and more heterogeneous; products are getting sleeker; and products are using more proprietary joints. In addition, the three industrial cases describe different problems in industry and how they can be tackled. Although many manufacturers have adapted the design principles of DFM and DFE, there is still much to improve when it comes to designing for the product's end-of-life processes. These kinds of adaptations should increase in importance over time as more and more products and components are remanufactured and/or material recycled. These kinds of adaptations will also encourage an increase of products passing through more resource efficient end-of-life options. Practical implications – Manufacturers reading what design problems other companies are experiencing and what solutions can be found would facilitate their own businesses and willingness to start their own and/or improve their existing manufacturing business. This could then be in shape developing products for end-of-life processes which also would encourage them to start their own end-of-life process facilities. Social implications – From a societal perspective, an increase in remanufactured products being placed on the market can increase the awareness and confidence of the consumers in non-new products made from non-virgin materials. This will increase the market for second-life products and bring about economics of scale, which in turn will alleviate the problem of depletion of resources. Originality/value – Most previous research in this area treats the different end-of-life processes separately; material recycling and product remanufacturing are but two examples. However, in this paper the focus is more on the overall view of end-of-life processes, along with examples of more specific and detailed end-of-life processes, such as disassembly and cleaning. ; funding agencies|Swedish Governmental Agency for Innovation Systems (VINNOVA)||Swedish Foundation for Strategic Research (SSF)||

Intro -- Contents -- List of abbreviations and acronyms -- Introduction -- Part 1 -- 1 Patient choice and consent -- 1.1 Choice: the traditional concept -- 1.2 Consumer choice, the free market and the health service -- 1.3 Some problems with consumerism in end of life care -- 1.4 Implications of a system for end of life care based on consumerism -- 1.5 The roots of the choice agenda -- 1.6 Conclusions -- References -- 2 Choice and best interests: clinical decision-making in end of life care -- 2.1 Understanding the clinical problem -- 2.2 Selecting the treatment options which offer a prospect of net benefit -- 2.3 Assessment of capacity -- 2.4 Making the final decision with patients who have capacity: consent -- 2.5 Making the final decision: patients without capacity -- 2.6 Conclusions -- References -- 3 Three logical distinctions in decision-making -- 3.1 Intended and foreseen consequences: doctrine of double effect -- 3.2 Acts and omissions -- 3.3 Killing and letting die -- 3.4 Conclusions -- References -- 4 Choice and best interests: life-prolonging treatments -- 4.1 Preliminary issues of ethical importance -- 4.2 Understanding the clinical problem -- 4.3 Selecting treatment options that offer a prospect of net benefit -- 4.4 Making the final decision with patients who have capacity -- 4.5 Making the final decision: patients without capacity -- 4.6 Conclusions -- References -- 5 Choice and best interests: symptom control and the maintenance of function -- 5.1 The basis of most moral problems in symptom control -- 5.2 Moral problems of symptom control in patients with capacity -- 5.3 Moral problems of symptom control in patients who lack capacity -- 5.4 Conclusions -- References -- 6 Choice and best interests: sedation to relieve otherwise intractable symptoms (terminal sedation) -- 6.1 Identifying the problems.

George P. Smith's Palliative Care and End-of-Life Decisions completes a Bioethics-Health Care epistemology begun in 1989, which addresses the specific issue of managing palliative care at the end-stage of life. Smith argues forcefully that in order to palliate the whole person (encompassing physical and psychological states), an ethic of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. Specifically, this book urges wider consideration and use of terminal sedation as efficacious medical care and as a reasonable procedure in order to safeguard a 'right' to a dignified death. The principle of medical futility is seen as a proper construct for implementing this process. The state legislative responses of California, Vermont, and Washington in enacting Death with Dignity legislation - allowing those with end-stage terminal illness to receive pharmacological assistance in ending their own lives - is held by Smith to be not only commendable, but the proper response for enlightened state action. ; https://scholarship.law.edu/fac_books/1020/thumbnail.jpg

This paper aims to identify common ground on end-of-life issues between the Islamic and Christian cultures. Since these two cultures are more and more coming to live in the same countries, it is important to acknowledge common ground since the laws of countries apply to all. The paper will deal with several issues, including the stopping of futile treatment, the administration of ordinary and extraordinary care, defining the difference between death and allowing one to die, and accepting death as sometimes being an inevitable and acceptable outcome. The paper will also discuss palliative care including pain relief and sedation. From here one delves into the case of Persistent Vegetative States and the morality of over-enthusiastic treatment which pushes people into this state.It will also focus on the differences, such as passive euthanasia and analyze whether this is merely a difference in the interpretation of terms. There is also a phenomenon in some countries on querying the removal futile treatment and on lacking a legal framework in general on end-of-life. At least one study shows concern on religious moral grounds. The conclusion attempts to identify the common grounds on the end-of-life and whether morality and laws in this regard are guided by religious positions. It is important that laws respect the moral normative values of populations, especially with pressure coming from more liberal positions. Even if practices such as euthanasia (the discussion of which is not the scope of this paper) are introduced in countries, it is important that health care (and legislation) recognizes the common moral ground, the lack of which may lead to more suffering. ; Cilj rada je utvrditi zajedničko stajalište između islamskih i kršćanskih kultura upitanjima o kraju života. Budući da ove dvije kulture sve više dijele zajednički životu istim zemljama, važno je utvrditi zajedničko stajalište, jer se zakoni u zemljamaodnose na sve. Rad uključuje nekoliko pitanja, uključujući prekidanje nepotrebnogliječenja, primjenu redovite i izvanredne skrbi, definiranje razlika između smrti idopuštenju osobi da umre te prihvaćanje smrti kao ponekad uistinu neizbježnogi prihvatljivog ishoda. U radu će se također raspravljati o palijativnoj skrbi, kojauključuje ublažavanje bola i sedaciju, a u kojoj se zadire u slučaj stalnih vegetativnihstanja i moralnosti pretjerano entuzijastičnog liječenja, zbog kojeg ljudi zapadajuu to stanje. Fokus rada će također biti na razlikama, kao što je pasivna eutanazija,i analizi je li razlika samo u tumačenju pojmova. U nekim zemljama vidljiva je ipojava u vezi s propitivanjem nepotrebnog liječenja i općenito nedostatka zakonskogokvira o kraju života. U barem jednoj studiji uočena je zabrinutost zbog vjerskihmoralnih razloga. U zaključku se pokušavaju utvrditi zajedničke osnove vezane uzskrb na kraju života i jesu li moralnost i zakoni u tom pogledu vođeni vjerskimpozicijama. Važno je da zakoni poštuju moralne normativne vrijednosti stanovništva,osobito pod pritiskom koji dolazi od strane liberalnijih pozicija. Čak i ako se uzemljama uvede praksa poput eutanazije (koja nije dio rasprave ovog rada), važno jeda zdravstvena zaštita (i zakonodavstvo) prepoznaju zajedničke moralne osnove čijinedostatak može dovesti do veće patnje.

End-of-life public policy has the potential to affect everyone. The purpose of this article is to provide an overview of recent significant policy activity. The authors begin by reviewing the Medicare and Medicaid hospice benefit and the Patient Self-Determination Act, highlighting state-level developments, and noting significant court cases. They then discuss common concerns with Medicare, advance directives, hospice, and pain management and provide proposed remedies for the concerns. The article ends with recommendations for advocacy by behavioral and social science professionals.

Waste management is gaining very high importance in recent years. As automotive is one of the most critical sectors worldwide, which is rapidly increasing, the management of end-of-life vehicles (ELVs) gains importance day by day. Due to legislation and new regulations, actors like users, producers, and treatment facilities are being conferred new responsibilities in the ELV management process. Besides, the ELV management is of vital importance for environment conservation, circular economy and sustainable development. All of these reasons are making the ELV management such a crucial issue to study. Today, the ELV management is a well-positioned and emergent research area. However, the available review papers are focused only on a small area of the ELV management, such as reverse logistics, recovery infrastructure, disassemblability, etc. Besides, a review of state-of-the-art mathematical models for the ELV management is still missing. This paper aims to provide an extensive content analysis overview of studies on the ELV management. A total of 232 studies published in the period 2000-2019 are collected, categorized, reviewed and analyzed. A critical review of the published literature is provided. Gaps in the literature are identified to clarify and suggest future research directions. This review can provide a source of references, valuable insights, and opportunities for researchers interested in the ELV management and inspire their additional attention.

International audience ; This paper examines the organization of death. Through an ethnographic study, we examine how a geriatrics department guides the end of life. Drawing on Agamben, we show that organizations that are dedicated to life, but regularly confronted with death, develop dispositifs (mechanisms, technologies, practices and relationships) to turn biopolitics (power over life) into thanatopolitics (a regime of death). We also show how the inherently political meaning of life disrupts such government of death. The inclusion of political life in a regime of death disrupts organizational practices that find themselves facing fundamental questions of what makes a life worth living, who can decide not to prolong life, and based on which criteria.

International audience ; This paper examines the organization of death. Through an ethnographic study, we examine how a geriatrics department guides the end of life. Drawing on Agamben, we show that organizations that are dedicated to life, but regularly confronted with death, develop dispositifs (mechanisms, technologies, practices and relationships) to turn biopolitics (power over life) into thanatopolitics (a regime of death). We also show how the inherently political meaning of life disrupts such government of death. The inclusion of political life in a regime of death disrupts organizational practices that find themselves facing fundamental questions of what makes a life worth living, who can decide not to prolong life, and based on which criteria.

This book offers an Ethical Framework for end-of-life decision making in healthcare settings. The Framework, consisting of eight Modules of Learning, is a set of educational resources for health professionals, allied professionals, healthcare ethics and law lecturers and students

Purpose of the article: In the article we have focused on the trends determining the development of reverse logistics of end-of-life vehicles in selected European countries. The analysis concentrates on quantity of end-of-life vehicles which are especially interesting for reverse logistics because of their fitness for recovery or reuse. End-of-life products contain fully valuable elements which, according to the idea of sustainable use of resources, should be recovered. Accordingly, reverse logistics aims at protecting natural resources and the environment through reintroduction of processed waste materials into the economic cycle as valuable products and materials. Methodology/methods: The aim of the article was achieved on the basis of a critical analysis of subject literature and the analysis of statistical data. In the article the method of descriptive and mathematical statistics and dynamic analysis were used. The 2006-2014 years were analyzed. The data come from the data base of the Eurostat, the statistical office of the European Union. The following variables were taken into account: the amount of end-of-life vehicles (in tonnes and in number of cars), reuse level (in tonnes), recovery level (in tonnes), and recycling level (in tonnes). The analysis was based on a t-Student test for two average values of dependent samples, sign test and the Wilcoxon signed rank test. In order to see if the reverse logistics actions implemented in European countries were effective, the analysis compares the average values of individual variables from the year 2014 and 2006. Measurements were done for the same countries on the same element of population. The chain indexes and the average change tempo for specified variables were calculated. The similarity of the formation of specified variables in each year was compared on the basis of the index of similarity structures. Scientific aim: The scientific aim of the article is to identify the basic trends determining the development of reverse logistics of end-of-life vehicles in selected European countries (Belgium, Bulgaria, Czech Republic, Denmark, Germany, Estonia, Greece, Spain, France, Italy, Cyprus, Latvia, Lithuania, Luxembourg, Hungary, The Netherlands, Austria, Poland, Portugal, Slovakia, Finland, United Kingdom, Norway). These trends are reflected in the amount of end-of-life vehicles designed for reuse, recovery and recycling. Findings: With respect to their total or partial processing, end-of-life vehicles are handled according to the 3R principle (reduce, reuse, and recycle) in order to promote the concept of sustainable development. Unfortunately, the number of end-of-life vehicles in Europe is increasing which is a result of the growing economy and society's wealth. Also the ecological awareness of the producers and consumers is rising which is reflected in the increased number of end-of-life vehicles put through reuse, recovery and recycling processes. The analyzed period shows an average annual increase in the reuse, recovery and recycling indexes in most of the discussed countries. Therefore, we can speak of an increasing ecological efficiency of sustainable logistics of end-of-life vehicles. Conclusions: Sustainable logistics allows to recover value from used products. End-of-life products contain materials of full value that should be recovered, which undoubtedly fosters sustainable use of resources. European countries vary according to both the effort and the result of the end-of-life vehicles recovery which is due to economic, legal and cultural circumstances. But research shows the existence of positive trends in the realization of reuse, recovery and recycling processes of end-of-life vehicles. These tendencies should delineate further activities in this area.