General Practice Observed: The Distress of Dying

A simple method of recording the distress of dying patients is described. Significant differences occurred between deaths at home and in hospital for three factors. Patients dying at home were (a) more likely to be fully alert shortly before death (P < 0·05); (b) less likely to be suffering from vomiting, incontinence, or bedsores (P < 0·001); and (c) less likely to have unrelieved physical distress (P < 0·05). No significant differences occurred in the distress of patients dying in general-practitioner compared with other hospitals, though the numbers compared were small and a larger study might prove useful.     

Assisted Dying & Disability

This article explores at least two dominant critiques of assisted dying from a disability rights perspective. In spite of these critiques, I conclude that assisted dying ought to be permissible. I arrive at the conclusion that if we respect and value people with disabilities, we ought to permit assisted dying. I do so in the following manner. First, I examine recent changes in legislation that have occurred since the Royal Society of Canada Expert Panel on End‐of‐Life Decision‐Making report, published in this journal. I suggest that these changes are likely to only strengthen opposition to assisted dying from disability rights activists and people with disabilities. Second, I focus on respect for people with disabilities and in particular, respect for their autonomy and decision‐making abilities. Third, I explore the opposition to assisted dying that focuses on risk and the vulnerability of people with disabilities. Here I suggest that this risk ought not to be of special concern. Ultimately, I conclude that upholding respect for the disabled requires the legalization of assisted dying, rather than the denial of access in a misguided effort to protect people with disabilities.     

The Dying Process: Patients' Experiences of Palliative Care

The Dying Process: Patients' Experiences of Palliative Care. Julia Lawton. London: Routledge, 2000. ix. 229 pp.     

The Animal Axis

Soft-bodied animals are an answer to the problem, solved foreach species over evolutionary time, to design a cylindrical,motile machine composed of pliant polymeric materials (collagenand glycoproteins) and actuated by a contractile polymer (actomyosin). The vertebrate body is a cylindrical set of pliant collagenousmembranes. Axial notochords and backbones occur where membranesintersect. The basis for all vertebrate architecture is thecollagen fiber that best functions to resist tension. Axialcompressive forces in notochords and backbones occur as tensilestresses in collagen fibers in intervertebral discs and zygapohysealligaments. Bone provides local stiffening where muscles pull.Large muscle masses apply large forces via tendons thus allowingfor leverage in the function of axes of bodies and appendages.Although isolated species in invertebrate phyla have notochord-or backbone-like structures, only echinoderms and vertebrateshave a central axis to resist axial compression. Design is auseful tool in forming scientific hypotheses.