9 research outputs found
Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study.
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69775.pdf (publisher's version ) (Closed access)To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the present study, we assessed whether or not this requirement is met in the Netherlands. We sent a retrospective questionnaire to 1,464 medical specialists, general practitioners, and nursing home physicians in the Netherlands. Furthermore, we held two sets of 20 and 22 semi-structured in-depth interviews with general practitioners, internists, lung specialists, and nursing home physicians. Although most guidelines discourage the administration of opioids alone for purposes of palliative sedation, opioids alone were administered for 22% of all the patients reported upon. Those physicians who were more experienced, general practitioners, and physicians who had consulted a palliative care expert administered only opioids significantly less often than the other physicians. The interviewees reported difficulties in assessing the appropriateness of medication, feeling uncertain about the pharmacokinetics of drugs used in moribund patients. Given that no more than 2% of the respondents perceived palliative sedation to be used as a form of euthanasia and that the use of opioids alone was not associated with shorter survival rates, the inappropriate use of opioids can only be attributed to a lack of knowledge or skill and/or a tradition of alleviating refractory dyspnoea with the use of opioids and not as an intentional means of hastening death
The impact of the inpatient practice of continuous deep sedation until death on healthcare professionals’ emotional well-being: a systematic review
Design for values in engineering
Values have probably always played a role in engineering design. However, in current practices and design methods, the attention for values in engineering design tends to be implicit and unsystematic. Establishing Design for Values in engineering would require overcoming this situation. This contribution discusses which values play a role in engineering and engineering design, describes existing methods and experiences with Design for Values in engineering, and explores how values can be integrated into engineering design and existing design methods, in particular quality function deployment (QFD). It identifies four challenges for Design for Values in engineering: (1) discovery of the values to be included in engineering design; (2) translation of these values into engineering characteristics; (3) choice among design options that meet different values to different degrees; and (4) verification of whether a design indeed embodies the intended values.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Values Technology and InnovationEthics & Philosophy of Technolog