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End of Life Care

End of Life Care


This program discusses care at the end of life, primarily focusing on pallative care of individuals and their families. The program's focus is on spiritual and supportive aspects of care rather than physical care. Information on the role and importance of advance care planning and advance directives is also presented.

DVD / 2013 / 35 minutes

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By James N. Kirkpatrick, MD

Controversy in diagnosing death has a long history, but the essential difficulties have not changed for hundreds of years. A major source of confusion in understanding death is the mixing of the definition of death¡Xa decision about when life has ended¡Xwith criteria and tests used to assess when death has occurred. What is it that shifts human beings from alive to dead¡Xlack of sentience? Lack of personhood? Cessation of all spontaneous biological activity? Departure of the soul? In this video, Dr. James Kirkpatrick revisits the concept of death. He traces the historical difficulties in diagnosing death, reviews the current controversies and criteria¡Xcardiopulmonary versus neurological¡Xfor determining death, discusses the legal and ethical issues surrounding organ harvesting, and explores the inherent problems with making the diagnosis of death a matter of personal choice.

DVD / 2010 / 30 minutes

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Death is inevitable and a natural part of life, but for the patient this important time can be difficult for the dying person and also their family and close friends. Therefore a health professional's role is to support the patient with maintaining their quality of life in this last stage of life. In this program we provide an introduction to the important aspects of good end of life care, looking closely at the key aims of end of life care, outlining the importance of advanced care planning; examine the use of medication and nutrition; and types of support offered for grieving families and friends. This program also features a number of health professionals who provide their expertise for this difficult topic.

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DVD / 2010 / (Professional) / 18 minutes

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By Bruce A Ellsweig, MD

"A medicine that embodies an acceptance of death would represent a great change in the common conception, and might set the stage for viewing the care of dying people not as an afterthought when all else has failed, but as one of the ends of medicine. The goal of a peaceful death should be as much a part of the purpose of medicine, as the promotion of good health." This quote from the medical ethicist, Daniel Callahan, serves as the foundation for this review of contemporary palliative care and hospice issues by Dr. Bruce Ellsweig. In this program, Dr. Ellsweig compares palliative and end-of-life care with the curative model of medicine. Recommendations for identifying patients who may be candidates for palliative care and/or hospice include eligibility criteria for the Medicare Hospice Benefit. A multidisciplinary approach to management with early and sustained communications between the patient, caregivers, family, and friends is critical to optimize end-of-life care and is stressed throughout the program.

DVD / 2009 / 30 minutes

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By Edmund Pellegrino, MD

Medical ethics encompasses a broad range of difficult clinical issues and decisions. Some of these issues, such as embryonic research, in vitro fertilization, cloning, and gene mapping, deal with the beginning of life. Others, such as those involving informed consent, organ donation, and human experimentation, can occur at any time during life. End-of-life decisions, including withdrawing and withholding treatment, euthanasia, and advance directives, comprise a significant and especially challenging part of medical ethics. In this program, Dr. William Matory interviews Dr. Edmund Pellegrino, a world-renowned spokesman on ethics and the medical profession. Dr. Pellegrino addresses end-of-life and other difficult decisions faced by physicians and other healthcare professionals in caring for patients, and provides clinically and morally sound advice, based on his belief in the moral nature of medicine and the ethical obligations of physicians.

DVD / 2006 / 60 minutes

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The end of life can raise numerous ethical issues. Prolonging life, advance directives, physician assisted suiside, and patient autonomy are just a few. Join this program for a discussion of these and other ethical issues.

DVD / 2004 / 30 minutes

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By Helen Emmott and Julie Russell

Claire is a nurse but, she says, "I've learned some things since I was the patient." Despite her training, she delayed seeing a doctor when she experienced the first symptoms of ovarian cancer. When the physician gave her the diagnosis, she understood the words, "but I couldn't hear anything he was saying." Later, in intense pain, she was refused stronger medication, told "We have to reserve that option for later." "Don't you understand I'm dying," she says. "My daughter is scared and angry, I'm using her college fund for treatment I believe to be futile, and I feel so completely alone." Shocked by the impersonality of her medical care she tells a student nurse, one of the few people to treat her kindly, "Don't ever forget the importance of just being with someone, especially someone who's dying."

Claire's Story is one in a series of brief, one-character dramas created by bioethics educators Helen Emmott and Julie Russell, who are both experienced registered nurses. Performed by Russell, these evocative portraits offer nurses, physicians, social workers and other members of the healthcare team invaluable case material for use in thinking about these issues.

Every day in the life of a terminally-ill patient presents a host of complex issues for patients, families, and members of the healthcare team. As medical science and technology continue to evolve, discussions of the ethical aspects of end-of-life care become both more critical and more difficult. Learning to facilitate and participate in these processes is essential for all healthcare providers. The cases portrayed in these poignant monologues will stimulate hours of ethical discussion.

  • "We teach and learn what it means to be healthcare professionals through cases, the sharing of clinical narratives or stories. The most powerful way of teaching and learning illness narratives is through drama, through actual performances of patients' stories." - William G. Bartholome, pediatrician and bioethicist

  • "The tapes and acting are magnificent, and the student response was wonderful!" - Dr. Lynda Shand, School of Nursing, College of New Rochelle

  • "Unforgettable! Russell's performance is inspiring, touching, and thought-provoking. The characterizations hit audience members right between the eyes." - Beth Ingram, Vice President, Arkansas Hospital Association

    DVD / 2004 / 17 minutes

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    By Walter L. Larimore, MD

    Helping a patient through the death process can be daunting and is rife with issues. In addition to medical challenges, there are religious/spiritual, emotional, ethical, financial, and legal matters to consider. The patient's spouse, family members, and close friends often look to the physician to coordinate these matters, and to provide guidance and support as the loved one's condition deteriorates. Dr. Larimore provides a comprehensive review of the physical and mental aspects of death and dying, and offers advice for helping patients and their families transition smoothly through the patient's end of life

    DVD / 2004 / 60 minutes

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    This DVD illustrates how death and dying impacts on both a client's spirituality and family members' spirituality. Key spiritual issues and needs that come to the forefront for palliative care clients and their families are also identified. Spiritual resources that can be used in the journey through the dying process are explored. How a person's/family's spirituality may impact on responses to death is presented. The role of the nurse in providing spiritual care to palliative care clients and their families is illustrated throughout the video.

    DVD / 2003 / 21 minutes

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    By Ben Achtenberg

    Ben Achtenberg's provocative documentary, Caring at the End of Life (45 minutes), raises a number of key issues faced by patients and those who care for them, including the role of technology, deciding when to use or withdraw life-sustaining treatments, the importance of effective pain management, and the impact of patients' culture, religion, and community on care decisions. Focusing on the key roles of nursing staff in patient care and communication, it profiles the cases of six severely ill hospitalized patients. The video offers no easy answers, but challenges viewers to think about and discuss their own hopes, fears, and beliefs. Achtenberg was nominated for an Academy Award for his earlier film Code Gray.

    The two brief, related study films listed below are designed to help audiences focus their discussion on particular areas of concern.

    Stanley (15 minutes): This disturbing case study presents a comatose patient whose family and healthcare team are in conflict over how long to continue with the treatments that are keeping him alive. In making decisions about his care, they confront difficult ethical questions about patient autonomy vs. the needs of the family, about who is in a position to judge what another person would want, about the role and impact of religious faith, and about the certainty or fallibility of medical judgement. Stanley combines several sequences from Caring at the End of Life, for groups who wish to discuss the implications of this particular case.

    Discussing Advance Directives (15 minutes): Two nurses and a physician, part of a foundation study on patient communication, meet to discuss the difficulties they encounter in working with other staff and patients on advance directives. Among these are misunderstandings, among both patients and staff, about the differing roles of living wills, durable powers of attorney, and "do not resuscitate" orders; confusion about how to interpret these documents in the light of changing medical circumstances; and the ambivalence of some patients about having to make such decisions at all. This thoughtful and sometimes amusing discussion expands a sequence seen in the longer film.

    These films were partially supported by the Robert Wood Johnson Foundation.

  • "Demonstrates the importance of collaborative practice in advance care planning and superbly highlights the critical role nurses can play in achieving better end-of-life outcomes." - Carol Taylor, CSFN, RN, PhD, Georgetown University Center for Clinical Bioethics

  • "Ben Achtenberg and Christine Mitchell have captured the complexity of end-of-life decision making. Health care professionals may see themselves and their colleagues in new ways that will hopefully encourage self-scrutiny and behavior change." - Mildred Z. Solomon, EdD, Center for Applied Ethics & Professional Practice

  • "These situations will ring true to practicing clinicians and offer an opportunity for stimulating discussions among students, clinicians, and all involved in health care." - Elizabeth F. Hiltunen, MS, RN, CS

    DVD (Closed Captioned) / 2002 / 75 minutes

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    By Patricia Barey & Therese Burson

    Everyone has a right to medical care that is competent, coordinated, and compassionate. Yet even the most competent of clinicians too seldom have the opportunity, or too seldom take the time, to really listen to the voices of patients and their family members. The articulate people in this program describe examples both of the best of end-of-life care, and of the worst. Their stories convey a vivid sense of the ways inadequate care has contributed to their pain and loss, and of how truly competent and compassionate physicians and nurses can change the character of the end-of-life experience.

    This film calls on caregivers to treat every individual with dignity and respect, to attend to family and caregiver needs, to provide physical comfort and emotional support, to communicate information sensitively, to share decision-making & foster a sense of control, and above all to listen.

    The program was developed as a training tool in connection with The Toolkit Project, an effort to create reliable tools to measure the quality of life and quality of care given to dying patients and their families.

  • "A haunting and profound visual reminder of the importance of knowing the individual, of the significance of quality care, and of the role of families. Highly recommended for all health programs, and colleges with nursing and medical programs." - Educational Media

  • Freddie Award Winner in Patient Care, International Health and Medical Film Festival
  • Merit Award, Mature Media Awards
  • Gold Award, National Health Information Awards

    DVD / 2002 / 25 minutes

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    Discussing end-of-life care with patients and their families can be very difficult. Despite the challenge, advanced planning helps to ensure that each patient can die as they wish. In this program you will learn the key points of an advanced directive and see examples of directives by statutes. These tools will not only teach professionals about the ethical dilemmas they face when end-of-life is near, but will also help families develop a sense of peace in this trying time.

    DVD / 2001 / 33 minutes

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    A Conspiracy of Silence looks at both the reluctance of patients to 'burden' their family members with their terminal illness, and the instinctive need family members feel to 'protect' their loved one from the truth. It also discusses ways caregivers can help families communicate, and go through all the stages of the illness together so they can openly comfort, support, and express their true emotions to each other and avoid feelings of guilt or regret later on.

    DVD / 20 minutes

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    The program suggests ways to offer comfort and provide the most beneficial treatment options for the elderly and terminally ill when they elect not to continue life-prolonging procedures. The program stresses the need for caregivers to give patients and families full disclosure of their choices, the potential side effects of those choices, and the expected, resulting quality of life. Decisions on pain assessment and management, hydration and tube feeding are discussed, as well as, the caregiver's role as a 'comforting presence' to the patient and the family.

    DVD / 37 minutes

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    This program will help caregivers to examine and come to terms with their own attitudes and emotions about death and the dying process. The program stresses the importance of caregivers learning to understand and accept death as the last, natural stage of the life cycle before they can effectively fulfill the physical, emotional, and spiritual needs of the patient (and the family members). Caregivers will learn that quality care for the dying goes past physical comfort and pain management to include giving the patient a choice in what happens during the final days of life, and respecting the diverse cultural traditions and spiritual needs of each patient.

    DVD / 20 minutes

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    This program will help caregivers to communicate openly with patients and their families about the terminal illness that the patient is facing, so the patient and family members can have the information they need to make appropriate decisions. The program documents the importance of being honest with the terminally ill person and their family members so they can:
  • understand, ask questions, and make critical choices together
  • experience acceptance and a sense of closure

    The program reinforces the role of the caregiver as a supporter of the decisions that are made in regards to treatment or non-treatment options, and encourages caregivers to openly express their own emotions about losing patients that they have come to know and care for over an extended period of time.

    DVD / 20 minutes

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    Robert N. Butler, MD; Sean Morrison, MD; Jane Morris, RN, MS; Kathleen M. Foley, MD, Robert Burt, JD

    How people die in the US; Differences, if any, in the ways men and women die; The common wish of patients to die at home; Financial costs associated with medical care of the dying; Myths and truths about physician's legal responsibilities to dying patients. How to assure a peaceful death.

    DVD / 90 minutes

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    This program presents a contemporary overview of residents' rights in the long term care context. It covers how residents' rights can be affected by other characteristics of today's long term care environment, including:

  • Increased cultural, ethnic, language and age diversity
  • More time and work-flow pressure on staff
  • The impact of outside stresses on staff, especially for single parents and employees working two jobs
  • What residents' rights are and why they are so important in the life and culture of a long term care facility
  • The specific rights everyone in a nursing home must understand and uphold
  • What staff, residents and family members should know about dealing with concerns and complaints early and effectively

    DVD / 20 minutes

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