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This episode presents an "Ethics Roundtable" discussion, focusing on the complex case of a 68-year-old female veteran, LK, whose advanced directive conflicts with her family's wishes regarding life-sustaining treatment. The source explores this ethical dilemma from multiple professional viewpoints, including a trauma surgeon, ethicist, spiritual care provider, physician, lawyer, and social worker. Each perspective offers insights into the challenges of honoring patient autonomy when a designated surrogate is deemed unsuitable and family members disagree with the patient's explicit end-of-life instructions. The central theme revolves around the legal and moral obligations to uphold a patient's advanced directive, especially when a surrogate's cognitive impairment or emotional distress prevents them from making decisions aligned with the patient's stated wishes.

keywords: autonomy, advance directive, surrogate decision making, substituted judgement

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This academic article explores the complexities surrounding dihydropyrimidine dehydrogenase (DPD) deficiency screening in patients receiving 5-fluorouracil (5-FU) based chemotherapy. The authors present a case study of a fatal reaction to capecitabine, a prodrug of 5-FU, to illustrate the severe, potentially life-threatening toxicity that can occur in DPD-deficient individuals. The text analyzes various methods of DPD testing, highlighting their limitations in meeting the criteria for routine screening, and discusses the ethical considerations of offering such testing. Ultimately, the article advocates for patient counseling on the risks of 5-FU and the option of DPD testing, while emphasizing the need for healthcare providers to monitor for early signs of toxicity and consider alternative therapies or dose reductions when appropriate.

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Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics

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Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics

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Cuirass Ventilation: An Alternative Home-Based Modality for Chronic Respiratory Failure" explores biphasic cuirass ventilation (BCV), a portable, non-invasive "forgotten" mode of respiratory support. This article highlights BCV's potential as a comfortable, home-based alternative for patients with chronic respiratory failure, particularly in palliative care settings

Onweni C, Rashid S, Goswami R, Treece J, Shipley LC, De Souza R, et al. Cuirass Ventilation: An Alternative Home-Based Modality for Chronic Respiratory Failure. Home Health Care Management & Practice. 2019:1-5. doi:10.1177/1084822319875111

Cuirass Ventilation: An Alternative Home-Based Modality for Chronic Respiratory Failure - Chidinma Onweni, Saima Rashid, Rachna Goswami, Jennifer Treece, Lindsey C. Shipley, Randal De Souza, Luke O’Neill, Tander Simberloff, Steven J. Baumrucker, 2020

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Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics

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Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics

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Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics

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As we move from the NCHPP website to our new home, we're porting our most popular series:  The ACHPN prep course.  It's free and may help you with enough questions to pass the darned thing.  It's a very poorly written exam, so get all the help you can!  You can do it!

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In this episode we discuss suzetrigine, a novel, non-opioid pain medication that specifically targets the NaV1.8 sodium channel to manage acute pain. The document explores its pharmacological mechanisms, highlighting how it blocks pain signals without causing the addictive or severe side effects associated with traditional opioids like respiratory depression or sedation. It reviews preclinical findings and clinical trial results, showcasing suzetrigine’s effectiveness in reducing postoperative pain with a favorable safety profile. The manuscript concludes by discussing suzetrigine’s potential to address the opioid crisis by providing a safer alternative for pain management, while also emphasizing the need for further research into its long-term applications.

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Thank you for your interest in Ethics in Palliative Medicine! Follow us at https://epionepalliative.com and on X: @PallCareEthics