"Patients with terminal cancer" who have neither terminal illness nor cancer

Breaking bad news in the era of artificial intelligence and algorithmic medicine: an exploration of disclosure and its ethical justification using the hedonic calculus

An appropriate ethical framework around the use of Artificial Intelligence (AI) in healthcare has become a key desirable with the increasingly widespread deployment of this technology. Advances in AI hold the promise of improving the precision of outcome prediction at the level of the individual. However, the addition of these technologies to patient-clinician interactions, as with any complex human interaction, has potential pitfalls. While physicians have always had to carefully consider the ethical background and implications of their actions, detailed deliberations around fast-moving technological progress may not have kept up. We use a common but key challenge in healthcare interactions, the disclosure of bad news (likely imminent death), to illustrate how the philosophical framework of the 'Felicific Calculus' developed in the eighteenth century by Jeremy Bentham, may have a timely quasi-quantitative application in the age of AI. We show how this ethical algorithm can be used to assess, across seven mutually exclusive and exhaustive domains, whether an AI-supported action can be morally justified.

If an assisted dying bill becomes law, medical and psychiatric safeguards must be extremely strict

During recent years, arguments supporting and opposing the legalisation of assisted dying have greatly intensified. The issue is a matter for society to decide, but physicians and psychiatrists have an essential role in informing public and parliamentary opinion on the contributions and limitations of medical knowledge related to the assessment of patients who request assisted dying and the necessity for strict safeguards should it be legalised. Some of the more important aspects of assessment and safeguards are discussed in this paper.

Treatable complications of cancer patients referred to an in-patient hospice

This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as “imminently dying” by the referring physicians.

The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.

Is a "palliative" patient always a palliative patient? Two case studies

Review of the literature suggests that misdiagnosis of terminal illness is infrequent. In the first 6 months of the recently established Edmonton Regional Palliative Care Program, two of 330 referrals proved to be in the category of erroneous diagnosis of terminal disease. These two cases are reported, along with discussion of aspects of the time-honored usefulness of careful history and physical examination. This experience highlights the importance of assessment, investigation, and aggressive therapy, even in "terminal" patients, including those in the geriatric population.

Acquisition and use of clinical data for audit and research

Acquisition of adequate patient data for clinical management is hard enough, but higher quality patient data are needed for clinical audit and research. This article discusses some of the problems of using routine clinical data for audit and research, aspects of data quality, sources of audit or research data and their problems, methods for improving data quality, the benefits and problems of computer-based systems and current trends in the capture and processing of clinical data.

Terminal care in a semi-rural area

In six months 157 patients died of malignant disease in West Cumbria, a semi-rural area, following a period of terminal care exceeding a week. A total of 53% of patients died at home compared with 24-41% in studies in metropolitan areas. In addition, over one-third of patients who died in hospital were in for a week or less. Patients living further from hospital were more likely to be cared for at home to the end of their illness. The emotional strain of home care was the commonest problem for the lay carer (74%). The commonest reasons for hospital admission were problems in providing care: in 22% of admissions there was no lay carer and in 45% the lay carer became unable to continue to give care. Nearly half the patients dying in hospital were in acute wards, frequently criticized by nurses and relatives as being unsuitable for dying patients. Despite the high degree of satisfaction expressed for the care provided in all settings, there was evidence of much avoidable suffering. A need for expert advice on palliative care was revealed.