Social Workers as Transition Brokers: Facilitating the Transition From Pediatric to Adult Medical Care

Transition from pediatric to adult medical care and the significant psychosocial considerations impacting this developmental process are a primary focus in health care today. Social workers are often the informal brokers of this complex and nuanced process and are uniquely trained to complete biopsychosocial assessments to understand the needs of patients and families and address psychosocial factors. Their extensive knowledge of resources and systems, along with their sophisticated understanding of the relationship issues, family dynamics, cultural implications, and basic person-in-context approach allow for unique collaboration with the health care team, family, and community supports to develop successful transition plans and programs.     

综合医院医务社会工作在慢病管理中的干预与对策

立足综合医院医务社会工作的优势,发挥其衔接过渡服务功能,提高慢病患者的焦虑处理能力、自我管理能力、服药遵从行为,可以促进慢病患者由综合医院就医诊疗为主体逐步平稳有序过渡到社区管理,逐渐实现以家庭为基础、社区为依托、专业机构为指导、社会广泛参与的慢病预防控制格局的目标。     

安乐死问题研究

安乐死作为一种使病人在无痛苦状态下度过死亡阶段而终结生命的人为方法,在医学、伦理、社会以及法律等方面具有十分重要的意义。一方面它可以减少那些生存无望的病人在精神上和躯体上遭受的极端痛苦,减轻病人家属所承受的经济负担,减轻社会医疗机构的压力,但另一方面它作为一种他人作为或者不作为而结束病人生命的方法,如使用不慎则会导致谋杀等许多社会问题。本文对安乐死的定义,主动安乐死,被动安乐死,目前安乐死在世界各国的立法及执行现状进行了较全面地阐述,指出对安乐死进行立法的必要性毋庸置疑。     

安乐死问题研究

安乐死作为一种使病人在无痛苦状态下度过死亡阶段而终结生命的人为方法,在医学、伦理、社会以及法律等方面具有十分重要的意义。一方面它可以减少那些生存无望的病人在精神上和躯体上遭受的极端痛苦,减轻病人家属所承受的经济负担,减轻社会医疗机构的压力,但另一方面它作为一种他人作为或者不作为而结束病人生命的方法,如使用不慎则会导致谋杀等许多社会问题。本文对安乐死的定义,主动安乐死,被动安乐死,目前安乐死在世界各国的立法及执行现状进行了较全面地阐述,指出对安乐死进行立法的必要性毋庸置疑。     

Measuring Satisfaction with Social Work Services

For various reasons, the role of the medical social worker is often unclear to persons seeking medical treatment. Allied health professionals, such as nursing staff, tend to have a better understanding of the medical social worker's role and of whether services are being provided to best meet each patient's needs. We aimed to illustrate the abilities of nursing staff to provide patient satisfaction feedback to medical social workers in such areas as responsiveness to patient requests and the satisfaction of patients and their family members with the social services provided. Use of this satisfaction measurement technique will hopefully resolve any confusion that patients, and others not familiar with the role of the medical social worker, may have. This method provides accurate measurement of patients' evaluation of medical social work services.     

Ethics policies on euthanasia in nursing homes: a survey in Flanders, Belgium

In many European countries there is a public debate about the acceptability and regulation of euthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing awareness of bearing responsibility for stimulating dialogue and reflection about how to deal with euthanasia requests within their institution.     

试析我国安乐死立法的必要性

安乐死合法化至少可以给社会带来如下的益处:避免法律纠纷;维护生命的权力和尊严;合理利用资源;减轻社会和家庭的负担。然而,我国关于安乐死问题的法律还是一个空白。作为一个人口众多的发展中国家,正面临着资源短缺,老龄人口急剧增加的问题,中国有必要加快对安乐死立法,使之早日合法化。     

An Exploration of the Themes and Content on Family Health in the Social Work Literature

This study is an exploratory study of the social work literature focusing on family health reported in the Social Work Abstracts from 1977 to the present. The findings suggest that the social work literature offers an extensive number of articles on topics related to family health. The implications of the findings for future research are offered.     

An Exploration of the Themes and Content on Family Health in the Social Work Literature

This study is an exploratory study of the social work literature focusing on family health reported in the Social Work Abstracts from 1977 to the present. The findings suggest that the social work literature offers an extensive number of articles on topics related to family health. The implications of the findings for future research are offered.     

Euthanasia and assisted suicide. I. How often is it practised by family doctors in The Netherlands?

A survey was conducted among family doctors to determine the frequency with which they were requested to administer euthanasia or assist in suicide, and how often they actually applied these procedures. Two random samples (in each n = 521) were taken from the population of Dutch family doctors (n = 6300) and requested to complete an anonymous questionnaire. The response was 67%. The entire body of Dutch family doctors practices euthanasia or assisted suicide about 2000 times per annum; 48% have never engaged in these practices. An average of 40% of all requests are complied with. We conclude that far fewer family doctors are involved in euthanasia and assisted suicide than was previously supposed. Euthanasia or assisted suicide was administered to 1 in 25 persons who died in their own homes.     

Cultural differences affecting euthanasia practice in Belgium: one law but different attitudes and practices in Flanders and Wallonia

Since 2002, Belgium has had a national law legalising euthanasia. The law prescribes several substantive due care requirements and two procedural due care requirements, i.e. consultation with an independent physician and reporting of euthanasia to a Federal Control Committee. A large discrepancy in reporting rates between the Dutch-speaking (Flanders) and the French-speaking (Wallonia) parts of Belgium has led to speculation about cultural differences affecting the practice of euthanasia in both regions. Using Belgian data from the European Values Study conducted in 2008 among a representative sample of the general public and data from a large-scale mail questionnaire survey on euthanasia of 480 physicians from Flanders and 305 from Wallonia (conducted in 2009), this study presents empirical evidence of differences between both regions in attitudes towards and practice of euthanasia. Acceptance of euthanasia by the general population was found to be slightly higher in Flanders than in Wallonia. Compared with their Flemish counterparts, Walloon physicians held more negative attitudes towards performing euthanasia and towards the reporting obligation, less often labelled hypothetical cases correctly as euthanasia, and less often defined a case of euthanasia having to be reported. A higher proportion of Flemish physicians had received a euthanasia request since the introduction of the law. In cases of a euthanasia request, Walloon physicians consulted less often with an independent physician. Requests were more often granted in Flanders than in Wallonia (51% vs 38%), and performed euthanasia cases were more often reported (73% vs 58%). The study points out some significant differences between Flanders and Wallonia in practice, knowledge and attitudes regarding euthanasia and its legal requirements which are likely to explain the discrepancy between Wallonia and Flanders in the number of euthanasia cases reported. Cultural factors seem to play an important role in the practice of (legal) euthanasia and the extent to which legal safeguards are followed.     

Explaining the emergence of euthanasia law in the Netherlands: how the sociology of law can help the sociology of bioethics

The debate over the legalisation of voluntary euthanasia is most often seen to be the result of three changes in society: individualisation, diminished taboos concerning death and changes in the balance of power in medicine. The fact that these changes occurred in many western countries but led to legalisation in only a few makes this claim problematic. I examine whether socio-legal propositions, with respect to the emergence of laws which focus on social control, offer a better approach to understanding the development of rules allowing and governing euthanasia. After a short sketch of the history of the Dutch law regulating euthanasia, I discuss these three societal changes in the light of shifts in the social control of medical behaviour that shortens life. I show that the Dutch relaxation of the prohibition of euthanasia goes together with new forms of social control: doctors' self control is complemented with second-party control (by patients), professional third-party control and governmental control. My work calls attention to the fact that bioethics is part of larger systems of social control.     

Trends in acceptance of euthanasia among the general public in 12 European countries (1981-1999)

BACKGROUND: We wanted to examine how the acceptance of euthanasia among the general public in Western Europe has changed in the last decades, and we wanted to look for possible explanations. METHODS: We analysed data from the European Values Surveys, held in 1981, 1990, and 1999-2000 in 12 West European countries. In each country, representative samples of the general public were interviewed using the same structured questionnaire in all countries. Euthanasia was explained in the questionnaires as 'terminating the life of the incurably sick'. RESULTS: A total of 46 199 respondents participated in the surveys. A significant increase in acceptance of euthanasia could be observed in all countries except (West) Germany. While the average increase in euthanasia acceptance was 22%, the increase was particularly obvious in Belgium, Italy, Spain, and Sweden. Although changes in several characteristics of respondents, such as decrease in religious beliefs, rising belief in the right to self-determination, and (to a lesser extent) rise in levels of education, were associated with growing acceptance of euthanasia, they could only partly explain the increase of euthanasia acceptance over the years. CONCLUSIONS: An increase of euthanasia acceptance among the general public took place over the last two decades in almost all West European countries, possibly indicating a growing support for personal autonomy regarding medical end-of-life decisions. If this trend continues, it is likely to increase the public and political debate about the (legal) regulation of euthanasia under certain conditions of careful medical practice in several West European countries.     

Attitudes towards euthanasia among physicians,nurses and the general public in Finland

The object of this study was to investigate the attitudes of physicians, nurses and the general public to physician-assisted suicide (PAS), active voluntary euthanasia (AVE) and passive euthanasia (PE) in Finland.Respondents received a postal questionnaire to evaluate the acceptability of euthanasia in five scenarios, which were imaginary patient cases. Age, severity of pain and prognosis of the disease were presented as background factors in these scenarios.This work was carried out in Finland in 1998.The respondents include a random selection of 814 physicians (506 responded, 62%), 800 nurses (582 responded, 68%) and 1000 representatives of the general public (587 responded, 59%).Thirty-four percent of the physicians, 46% of the nurses and 50% of the general public agreed that euthanasia would be acceptable in some situations. Of the scenarios, PE was most often considered acceptable in cases of severe dementia (physicians 88%, nurses 79% and general public 64%). In the same scenario, 8% of physicians, 23% of nurses and 48% of general public accepted AVE. In the scenario of an incurable cancer, 20% of the physicians, 34% of the nurses and 42% of the general public accepted PAS. All forms of euthanasia were generally more acceptable in older, than in younger, scenario patients.This paper conclude that PE was largely accepted among Finnish medical professionals and the general public. Only a minority favored AVE and PAS.     

The practice guideline 'Dementia' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

With growing numbers of older adults in the population, the number suffering from dementia will increase. The general practitioner has to try to determine the difference between Alzheimer's disease and vascular dementia on the one hand, and fronto-temporal dementia and dementia with Lewy bodies on the other hand, while also considering the therapeutic options now and in the future. Support for patients and their family is the responsibility of the general practitioner, who must also consider the patient's driving proficiency and the wishes for euthanasia of the demented older adult. The revised version of the practice guideline 'Dementia' of the Dutch College of General Practitioners is well suited to the work of the general practitioner. It is advisable to read the practice guideline several times and in such cases not only to use the summary card but the entire practice guideline.     

Confusion between euthanasia and other end-of-life decisions: influences on public opinion poll results

BACKGROUND: Public opinion polls indicate that a majority of Canadians are in favour of euthanasia. However, there have been many criticisms of the validity of these findings. The objective of this study was to assess public opinion towards euthanasia while controlling for possible threats to validity indicated in the literature review. METHODS: A telephone public opinion poll was conducted in 2002 with a representative sample of the general population of Quebec (n = 991; response rate = 49.8%). Respondents were asked about their support for euthanasia and treatment withdrawal and, for comparison, were asked a previously used question on euthanasia (Gallup) which has been criticized for methodological problems. Respondents were also asked to distinguish between euthanasia and other end-of-life decisions in hypothetical scenarios. RESULTS: Eleven percent more people supported euthanasia with the Gallup question than the question developed in this study. Support for euthanasia (69.6%) was less prevalent than for treatment withdrawal (85.8%). Respondents who failed to distinguish between euthanasia and treatment withdrawal or withholding treatment in hypothetical scenarios were more likely to support euthanasia in public opinion poll questions. Furthermore, there is a significant relationship between opinions about the acceptability of euthanasia and inaccurate knowledge of the nature of euthanasia. INTERPRETATION: Public opinion polls on euthanasia must be interpreted in the light of the wording of the question. Education of the population concerning euthanasia and other end-of-life decisions may be considered to be an important prerequisite to engage in public debate concerning the legalization of euthanasia.