Respect for an individual’s autonomy determines that doctors should inform patients if their illness is terminal. This becomes complicated when the terminal diagnosis is recent and death is imminent. The authors examine the admission to paediatric intensive care of an adolescent with terminal respiratory failure. While fully ventilated, the patient was kept sedated and comfortable but when breathing spontaneously he was capable of non-verbal communication and understanding. Once resedated and reintubated, intense debate ensued over whether to wake the patient to (...) tell him he was going to die. The authors discuss the ethical arguments that surrounded their decision. (shrink)

Physician-written “do not resuscitate” DNR orders elicit negative reactions from stakeholders that may decrease appropriate end-of-life care. The semantic significance of the phrase has led to a proposed replacement of DNR with “allow natural death” . Prior to this investigation, no scientific papers address the impact of such a change. Our results support this proposition due to increased likelihood of endorsement with the term AND.

Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate decision in a university in Hong Kong, and the factors affecting their attitudes.Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated.Results: A total of 766 students participated in the study. There were statistically (...) significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient’s own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR.Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient’s own wish as most important in DNR decisions. Family wishes were considered less important than the patient’s own wishes. (shrink)

Background: Recent studies on public attitudes toward life extension technologies show a mix of ambivalence toward and support for extending the human lifespan. Attitudes toward genetic modification of organisms and technological enhancements may be used to categorize individuals according to political or ideological orientation such as technoprogressive or conservative and it could be easy to assume that these categories are related to more general categorizations related to culture, e.g. between Traditional and Secular-rational values in the World Values Survey. This paper (...) discusses how attitudes toward aspects of radical life extension may be related to cultural values as revealed in an online deliberative survey among university students conducted between January 2012 to January 2013. Survey results suggest that attitudes toward radical life extension tend to be mixed among groups categorized as Traditional, Secular-rational, Survivalist, and Self-expressionist. The study explored the relation between responses of 326 university students to 5 key questions on radical life extension and the cultural values they tend to favor as indicated by their response to 20 statements from the World Values Survey.Design and Method: The survey consisted of 3 stages: an online pre-discussion survey, face-to-face discussion, and post-discussion survey. After completing the 5 main survey questions in stage 1, participants were presented two additional questionnaires: one on cultural attitudes using 20 statements from the 2004-2008 World Values Survey and another on health attitudes with 12 statements from Dutta-Bergman’s 2004 study. In stage 2, participants were engaged in a face-to-face discussion in class focusing on their responses to the five key questions. After the discussion, they were invited to reconsider the choices and reasons they posted in stage 1 in the light of the face-to-face class discussion in stage 2.Results: Responses to the five survey questions showed that there tended to be more individuals across groups who disagreed with adopting technologies that radically extend the human lifespan beyond the current limit of 120 years. Attitudes toward radical life extension did not correspond to cultural attitudes indicated by responses to the WVS questions. The proportion of agreement/disagreement to statements presented in each of the five questions varied across cultural groups and there tended to be more individuals who disagreed with radical life extension in all groups. Changes in responses after the discussion stage were not significant and most respondents maintained their prior views.Discussion: Cultural attitudes associated with familiar technologies may not correspond with attitudes toward newer technologies since beliefs and values may need to be adapted to new imagined situations that the new technologies elicit. Moral understandings associated with familiar technological habits and beliefs are not necessarily carried over to new technologies. (shrink)