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Generations

Articles from Vol. 23, No. 1, Spring

Addressing End-of-Life Issues: Spirituality and Inner Life
The importance of magic, play, and the sacred in confronting the ultimate dilemma posed by our mortality. Recent years have witnessed an unprecedented growth of interest in religion and spirituality. Since the 1980s, a large number of studies have investigated...
Caring for Caregivers of Frail Elders at the End of Life
Common problems and promising models. Caregiving for dying, rail elders places an enormous burden on family members and paid caregivers. Most people 65 and over live independently with minimal assistance. But as they approach death, a substantial number...
Coping with Death: Anticipatory Grief and Bereavement
Death is nothing at all. I have only slipped away into the next room. I am I, and you are you. Whatever we were to each other, that we still are. Call me by my old familiar name, speak to me in the easy way which you always used to. Put no difference...
Death and Dying in the 1990s: Intimations of Reality and Immortality
To me alone there came a thought of grief: A timely utterance gave that thought relief. . . -William Wordsworth How has death become a popular issue? As the decade comes to da close, it is an opportune time to reflect on death and dying in America. As...
Decisions at the End of Life: Cultural Considerations beyond Medical Ethics
In multicultural America, members of most ethnic groups manage to live lives of peaceful coexistence. Day-to-day encounters with members of other groups often center on relatively superficial concerns. However, as elders approach the end of their lives,...
Looking beyond the Law to Improve End-of-Life Care
What is the next step? Law is a collection of tools of limited utility. --Roger B. Dworkin, Limits With the best of intentions, and some measure of success, advocacy to improve end-of-life care and decision making over the past twenty-five years has...
Old Age and Care near the End of Life
We have transformed our view of death: Rather than an accepted part of life's experience, it is now seen as an unfamiliar and much feared event. Popular images of death and dying are a jumble of gun violence, young and middle-aged adults on television...
Pain and Suffering at the End of Life for Older Patients and Their Families
The relief of pain and JL suffering, the foundation of palliative care, is a formidable challenge to clinicians and researchers. Both pain and suffering are complex, multidimensional concerns, and the many demands of aging create additional challenges...
Palliative Care in the Nursing Home
For a variety of reasons, the quality of dying in this setting leaves much to be desired. Approximately one out of every five deaths in the United States occurs in nursing facilities, although the quality of dying in this setting leaves much to be desired....
Sexuality in the Nursing Home: Iatrogenic Loneliness
A major fear of the dying is that of loneliness, of dying alone. The barriers that the nursing home places to the development and nourishment of intimacy become pro foundly important as residents near the end of their lines. As death approaches, it is...
Should It Be Legal for Physicians to Expedite a Death?
No A Change of Heart on Assisted Suicide A recent survey, which AI co-wrote, found that doctors are often asked by their patients for help in dying, but seldom honor these requests. Some years ago, I believed that doctor-assisted suicide should be legalized...
The Problem Isn't Payment: Medicare and the Reform of End-of-Life Care
The forces that have produced our current disaffection with the process of dying are much more fundamental and less tractable. Of the roughly 2.4 million Americans who die each year, approximately 75 percent are insured by Medicare at the time of their...
Training Advanced Practice Palliative Care Nurses
Beyond just the physical managemnt of disease. The aging of the population has changed the nature and the needs of people who are dying and has contributed to the recent movement to ensure quality of life and quality of dying at the end of life. Important...
Training Physicians in Palliative Care
A our population ages, it is imperative that we train the doctors of tomorrow to be adept in issues of end-of-life care and advanced-care planning. The medical field that specializes in the care of patients with advanced, progressive disease where the...
When a Patient Requests Help Committing Suicide
The relationship between doctor and patient as it influences decision making. Mrs. C was a 69year-old woman with a ten-year history of systemic lupus erythematosus. She suffered from severe osteoporosis and muscle wasting as a result of long-term corticosteroid...
Working in the Dark: The State of Palliative Care for Patients with Severe Dementia
We fail to recognize such common symptoms as pain, and the current standard of care often does not achieve the ends we expect. We work in the dark-we do what we can-we give what we have. Our doubt is our passion and our passion is our task. -Henry James,...