Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea.Gasping respiration is also referred to (...) as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated.We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death. (shrink)

Palliative care is experiencing an upsurge in interest and importance. This is driven, paradoxically, by modern medicine's increased ability to provide effective pain relief on the one hand and an acknowledgement of its limitation in delivering a cure for certain diseases on the other. With many Muslims suffering from such incurable diseases worldwide, they too are now faced with the decision of whether to avail themselves of pain relief offered within the framework of scientific medicine. However, while the general ethos (...) of palliative care which is to promote the quality of life of those facing life-limiting illnesses is consistent with Islamic values, this paper explores whether the same can be submitted for modern methods of pain control. The investigation will be steered by two overriding questions. First, if pain and suffering could, as highlighted in the primary sources of Islamic Law, lead to the expiation of sins, can pain relief be taken? Second, is it religiously permissible to choose pain treatment options that could bring about iatrogenic addiction, the hastening of death and the impairment or obliteration of consciousness? (shrink)

Although older persons (aged 65 years and older) experience stressful ethical problems involving their health, research is lacking about this phenomenon. The purpose of this study was to describe and examine the content and basic nature of older persons’ ethical problems concerning their health. The conceptual framework and method combined ethical enquiry and phenomenology. The participants were 18 older persons and 12 of their children or grandchildren (for contextual understanding). The 19 women and 11 men, 73% of whom were Caucasian, (...) described 184 ethical problems, from which emerged 10 content categories. The basic nature of the ethical problems consisted of conflict, resolution and rationale. The results could assist health professionals to promote older persons’ ethical decision making, quality of life, and good death. (shrink)