False dichotomy versus genuine choice the argument over physician-assisted dying

Journal ArticleDespite a growing consensus that palliative care should be a core part of the treatment offered to all severely ill patients who potentially face death,1 challenging questions remain. How broad a choice should patients have in guiding the course of their own dying? What limitations should be placed on the physician's obligation to address patients' suffering? Physician-assisted death (also called physician-assisted suicide or physician aid in dying) has long been the focal point of ethical and political debate-a divisive, hot button issue in a domain in which there is otherwise considerable agreement

Excellent palliative care as the standard, physician-assisted dying as a last resort

Journal ArticleTo understand the role of physician-assisted death as a last-resort option restricted to dying patients for whom palliative care or hospice has become ineffective or unacceptable, one must understand how frequently and under what circumstances that occurs. If all such cases are the result of inadequately delivered palliative care, then the best answer would be to improve the standard of care and make the problem disappear. Most experts in pain management believe that 95 to 98 percent of pain among those who are terminally ill can be adequately relieved using modern pain management,1 which is a remarkable track record?unless you are unfortunate enough to be in the 2 to 5 percent for whom it is unsuccessful. However, among hospice patients who were asked about their pain level one week before their death, 5 to 35 percent rated their pain as "severe" or "unbearable."2 An additional 25 percent reported their shortness of breath to be "unbearable" one week before death.3 This says nothing of the physical symptoms that are harder to relieve, such as nausea, vomiting, confusion, and open wounds, including pressure sores, which many patients experience.

Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses

Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses

Pharmacological Targeting of Native CatSper Channels Reveals a Required Role in Maintenance of Sperm Hyperactivation

The four sperm-specific CatSper ion channel proteins are required for hyperactivated motility and male fertility, and for Ca2+ entry evoked by alkaline depolarization. In the absence of external Ca2+, Na+ carries current through CatSper channels in voltage-clamped sperm. Here we show that CatSper channel activity can be monitored optically with the [Na+]i-reporting probe SBFI in populations of intact sperm. Removal of external Ca2+ increases SBFI signals in wild-type but not CatSper2-null sperm. The rate of the indicated rise of [Na+]i is greater for sperm alkalinized with NH4Cl than for sperm acidified with propionic acid, reflecting the alkaline-promoted signature property of CatSper currents. In contrast, the [Na+]i rise is slowed by candidate CatSper blocker HC-056456 (IC50 ∼3 µM). HC-056456 similarly slows the rise of [Ca2+]i that is evoked by alkaline depolarization and reported by fura-2. HC-056456 also selectively and reversibly decreased CatSper currents recorded from patch-clamped sperm. HC-056456 does not prevent activation of motility by HCO3− but does prevent the development of hyperactivated motility by capacitating incubations, thus producing a phenocopy of the CatSper-null sperm. When applied to hyperactivated sperm, HC-056456 causes a rapid, reversible loss of flagellar waveform asymmetry, similar to the loss that occurs when Ca2+ entry through the CatSper channel is terminated by removal of external Ca2+. Thus, open CatSper channels and entry of external Ca2+ through them sustains hyperactivated motility. These results indicate that pharmacological targeting of the CatSper channel may impose a selective late-stage block to fertility, and that high-throughput screening with an optical reporter of CatSper channel activity may identify additional selective blockers with potential for male-directed contraception

Multi-disciplinary efforts to evaluate the therapeutic potential of CDK11, a novel transcription associated cyclin dependent kinase.

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Physician assisted death in vulnerable populations

Claims of increased risk in these groups are not supported by evidenc