Literature Review

As ‘right to die’ gains more acceptance, a scholar of Catholicism explains the position of the Catholic Church The Conversation; by Mathew Schmalz; 3/31/25 An individual’s “right to die” is becoming more accepted across the globe. ... Assisted suicide is now permitted in 10 U.S. states and in Washington. In 2025,five more states are set to consider “right to die” legislation. The “right to die” can refer to several means of dying. ... [Descriptions of terms "right to die," "euthanasia," "assisted suicide/dying."] ...

Palliative care clinic offers supportive care for patients with end-stage heart failure Yale School of Medicine; by Rachel Martin; 3/25/25 ... Michael Beasley, MD, [Yale] assistant professor of medicine (cardiovascular medicine), and Nora Segar, MD, [Yale] assistant clinical professor (general internal medicine) and director of palliative medicine at the Saint Raphael Campus of Yale New Haven Hospital, recently established a new outpatient clinic to provide dedicated palliative care for people with end-stage heart failure. ... “For many patients with advanced heart failure, hospice care does not meet their needs until very late in their course,” said Segar, an early champion of the clinic. “Instead, by providing early palliative care outside of the hospital, when it’s not a time of crisis, we can help patients accept and cope with their prognosis, manage their symptoms, and continue making plans for the future.” New patients receive longer appointments, which allows the team to hear their stories and start building relationships with them. [Continue reading ...]Editor's note: For all palliative and hospice leaders, we highlight this last statement: "New patients receive longer appointments, which allows the team to hear their stories and start building relationships with them."

Assisted ventilation withdrawal in motor neuron disease: updated results BMJ Supportive & Palliative Care; by Lucy Bleazard, Jonathan Palmer, David Wenzel, Thomas Jeffery, and Christina Faull; 3/24/25 Introduction: Patients with ventilator-dependent motor neuron disease (MND) may request withdrawal of their assisted ventilation. Facilitating this process as a healthcare professional (HCP) can be emotionally and practically challenging. The Association for Palliative Medicine (APM) issued guidance to support HCPs and invited anonymised accounts of the withdrawal process to provide an update on the guidance. ... Results: Younger patients tended to need higher doses to achieve adequate symptom management prior to withdrawal. Practices of weaning the ventilator varied significantly between respondents. The median time to death following withdrawal of ventilation was 30 min, with three-quarters of patients dying within 2 hours. Conclusion: This is the largest data set to date regarding the withdrawal of assisted ventilation in MND. This updated analysis reaffirms that a personalised, titrated approach remains appropriate and effective. The revised APM Guidance 2025 incorporates new sections on recommendations for managing the ventilator. [Continue reading ...]

Carolyn Hax: Does sibling love justify traveling to abusive mom’s deathbed?The Washington Post, Washington, DC; 3/24/25 Sister asks the letter writer to join her at their dying mom’s bedside — despite their PTSD-inducing childhoods. [The rest of this article may require a subscription to The Washington Post.]Editor's note: Even if you're not able to access the full article, what does this question stir in you? Be aware that many family caregivers (or simply family members) face complex, conflicted relationships with the persons they are tending--or in this case, even considering visiting or not. Be attuned to these common, everyday occurrences that your direct care interdisciplinary team members regularly navigate. What family systems' education and support do you provide for them?

Health care system adaptation and resilience during the wildfire crisisJAMA Network; by Attila J. Hertelendy, PhD, Jeremy Maggin, MD, MS, and Gregory Ciottone, MD; 3/19/25 ... Within a span of hours, the Palisades and Eaton fires, propelled by record-breaking Santa Ana winds reaching 150 miles per hour, consumed more than 37,000 acres, destroyed more than 16,000 structures, and claimed 29 lives. All told, greater than 186,000 residents were placed under evacuation orders. ... The experience in Los Angeles County demonstrates the value of maintaining dual-purpose resources: facilities and personnel who can transition between routine operations and emergency response functions. This approach is exemplified by Kaiser Permanente’s successful deployment of mobile health vehicles and the use of clinically trained administrative leaders in direct patient care roles during crisis events. Key elements of successful resource mobilization include:

From heroes to burnout: How we failed our frontline health workers MedPage Today's KevinMD.com, and excerpt from Health Care Nation; by Tom Lawry; 3/15/25 Of all the lessons learned from fighting a pandemic, none was more frightening or important than discovering how dependent the system is on how we treat our doctors, nurses, and frontline caregivers.  They were already in short supply, with burnout on the rise, when the pandemic hit. As multiple waves of COVID-19 variants washed over us, frontline health workers stepped in at great risk and personal sacrifice to care for highly infectious patients. ... Some witnessed more deaths on a double shift than they did in a normal year. They delivered the bad news to families and managed end-of-life care. They were often the last face and warm voice a COVID-19 victim saw and heard. In the end, they not only saved lives but saved the system from total collapse. ... We called them heroes. And we promised to do better in how we treated them once the COVID-19 crisis passed. Promises made should be promises kept. While we continue to talk about workforce burnout using polite terms with concern in our voices, let us be clear: A system with a mission of healing continues to harm in record numbers the very people in short supply who are there to take care of the rest of us. ... [Click on the title's link for more.]

End-of-life conversations: ‘When they open the door, you have to go in’ Oncology Nursing News; by Pattie Jakel, MN, RN, AOCN; 3/13/25Oncology nurses have a unique relationship with patients that allows for difficult but essential end-of-life conversations, says expert Patricia Jakel, MN, RN, AOCN. Jakel, one of the editors in chief of Oncology Nursing News, emphasized that following up with patients and ascertaining what answers and support they need comes with the close bonds that oncology nurses form with patients with cancer. ... [Jakel describes:] We play a really important role. And sometimes patients ask us difficult questions, and we have to be prepared for it. I remember a lovely young patient I had, she had 2 little girls, and she was very sick. And things weren’t going well for her in the hospital, and she just—she looked up at me and she said, "Am I dying today?" And I thought, "She’s opening the door. She needs to have this conversation.” And I said, “It’s not going to be today, but I think it’s going to be soon.” And she kind of chuckled, because her sister was at the bedside, and she said to her sister, “I need my makeup done. I want my makeup on today, if today’s not the day.” And that took us to a whole conversation about what dying would look like for her.Editor's note: Read and share this significant, sensitive video/article from its source, Oncology Nursing News. What communication education and support do you provide for your nurses? Explore this similar article from Oncology Nursing News, "APPs, Oncologists Work Together for End-of-Life Discussions," 11/2/24.

Spiritual well being at Kaiser HMG - Hews Media Group, Los Cerritos Community News, Los Angeles, CA; 3/13/25 At Kaiser Permanente Downey Medical Center, the hospital and staff are committed not only caring for the patient’s physical, emotional and mental wellness, but just as importantly to their spiritual well-being. ... Chaplains at Downey Medical Center are called upon when a patient and/or family is:

Palliative care nurse specialists' perspectives on spiritual care at end of life-A scoping reviewJournal of Hospice and Palliative Nursing; Bronagh Dunning, Michael Connolly, Fiona Timmins; 3/25The research demonstrates that specialist palliative care nurses perceive spiritual care as an important element of holistic care at end of life; however, these nurses also agree that spiritual care is lacking. This deficiency results from a lack of education in spirituality; experience of the nurse; the nurses' own spiritual and religious beliefs and values, fears, and difficulties in communication; and the nurse-patient relationship. The findings demonstrate the necessity to increase the level of spiritual care education in nurse programs, educating nurses on the provision of spiritual care, and how to deal with conflicts in spiritual and religious beliefs.

Here’s to Laura Ptucha-Skoog, hospice nurse YubaNet.com; by Timothy May; 3/10/25 “I’m not sure I’d say much at all, not at first. I would just try to listen.” This in response to the question of how a hospice nurse should respond if patients or family members make demands that seem unreasonable, unwise, or downright impossible. ... Laura Ptucha-Skoog should know; she has been an R.N. for decades and a nurse at Hospice of the Foothills for the last nine years. She loves her job, including the challenge of facilitating communication. Her ability to talk frankly with terminally ill hospital patients and families drew her to a career in hospice. “Often,” Laura explains, “the human elements are as challenging as the medical ones. Things like asking the right questions and listening to responses; making sure your patient and their caregivers understand what you are doing and why; verifying that everyone understands where you are in the process; listening to their responses with patience and empathy.” ... 

Palliative care clinicians goals-of-care notes more extensive than other providers’ documentation Hospice News; by Jim Parker; 3/5/25 A team of researchers has developed a standardized goals-of-care note to document patient wishes in the electronic medical record. Many patients do not experience goals-of-care conversations in a timely manner. But even among those who have, their wishes can get lost if they are not documented. The standardized note created by a research team from the Regenstrief Institute, the Indiana University School of Medicine and Indiana University Health can help health care providers be aware of and access patients’ goals of care, according to lead investigator Dr. Alexia Torke. ... The research on the note was published in the American Journal of Medicine.

My mother and brother have terminal cancer. I'm worried I won't feel anything when they die. Business Insider; essay by Kimanzi Constable; 3/1/25 ... My brother was diagnosed with Cutaneous T-cell lymphoma (CTCL) three years ago, and my mother found out she had stage four lung cancer a year ago. I got a call earlier this year that the cancer was spreading, and I flew to spend time with them. I knew it would be hard seeing them battling late-stage cancer, but what I walked into was my brother in the Advanced Cancer Care Center, unable to move, and my mother wanting to hold an "end of life" planning meeting. It was worse than I anticipated. It was hard to see him not moving and the nurses having to help him do everything. My mother looked like she weighed 50 pounds ... I'm worried I won't feel anything when they pass away. ... I think it might be just another day when they pass away. I've been thinking — what does that say about me? Am I a bad person for not falling on the ground and losing it for over half of my family dying? Or is this nothingness an OK feeling due to the complicated relationship we've had most of my life? ... Editor's note: Leaders, welcome to the daily world of your clinicians, especially your social workers, chaplains, and grief counselors. Read this with openness to the normalcy of this author's conflicted relationships, emotions, thoughts, and empowered actions toward "not wanting to regret how I handled this opportunity to say goodbye more healthily."