Readers' Forum

Readers' Forum We strongly support the message of this Round overcomes this problem and is the optimal Table. The dimension of the problem is approach for dying with dignity. underlined by a report from the Netherlands that 25 000 persons have asked their doctors for For the assistance of cancer patients at home assurance that they will assist them to die if we do not advocate a special service aimed suffering is unbearable (2). We found, as in the exclusively at terminal care; that can be Diabetes mellitus in the elderly Dutch study, that loss of dignity (50-60%) and undertaken by general practitioners. Instead, • Urine glucose monitoring with a view. to pain (40-50%) are the main arguments for we have developed the hospital-at-home as an changing the treatment regimens is not requests for euthanasia. But both can be approach providing both advanced and terminal SIR- The WHO Expert Committee on Health advised, as renal thresholds for blood glucose mastered. Therefore, we consider euthanasia to patients with highly specialized oncological care of the Elderly reports that, by the year 2000, level may in any case be high in the elderly. be the expression of medical and social inability outside the hospital. A hospital-at-home is two-thirds of the elderly population in the world • Long-acting drugs (insulins or oral drugs such to realize a basic human right - a death in peace organized along the lines of a conventional will be living in the developing countries (1). as chlorpropamide) should not be and dignity as the harmonious end of biological hospital. It provides patients with specialized, As diabetes mellitus in the elderly is a administered routinely. life. hospital-standard diagnostic tests and treatment recognized public health problem the number of in the comfort of their own homes. diabetics seeking medical attention is therefore • If the subject needs insulin, pre-loaded To provide an alternative to euthanasia, the first expected to rise. At a low estimate, the diabetic injection kits with simple techniques are author formulated in 1985 the concept of With this approach we achieved a reduction of population above the age of 65 years in preferred, especially when vision is impaired. eubiosia, "the set of qualities that endows life pain from 30-35% to 5-7% in advanced cancer alone will be over two million. • An edentulous old person living alone may with its dignity". Eubiosia is considered a human patients. More than 60% of the patients right that permeates man's existence from the evaluated this service as better than traditional We analysed our hospital records in a randomly not follow the diet planned; it is not easy for moment he is born until the moment he dies. hospital service, and 70% chose to die at home. selected period, 1 October 1983 to 30 September the elderly to follow diet, drug and exercise schedules scrupulously. 198~, ~nd found that there were 3638 inpatient F. Pannuti & Stephan Tanneberger In contrast to the worldwide discussions on admIssIons of people over 65. The main reasons • Skin care is very important, as both senility Division of Medical Oncology, protection of embryonal life and on the rights of were neoplasms (12.6%), infections (9.6%), and diabetes can predispose the skin to Sant'Orsola Malpighi Hospital, an embryo (including parliamentary debate in cerebrovascular accidents (4.5 %), diabetes dryness and further complications. Via Albertoni 15, 40138 Bologna, mellitus (4.2%), and ischaemic heart disease ), the problem of the dignity of dying is widely ignored by both the medical communities (2.7%). Similar trends are continuing. This V. Seshaiah & V. R. R. Kodali and the media. For this reason in spring 1992 analysis shows that diabetes mellitus in the Department of Diabetology, 1. Pannuti, F. & Tanneberger, S. The Bologna elderly is a significant cause of hospital Madras Medical College, we started an initiative with regard to legislation Eubiosia Project: hospital at home for advanced admission in India and emphasizes the need for Government General Hospital, on "Rights for dying". We have already collected cancer patients. Journal of palliative care, 8(2): specialized care and expansion of facilities. Madras 600003, India 1250 signatures pledging agreement with the 11-18 (1992). project in Italy, and we are encouraged to bring 2. Van der Maas, P. D. et al. Euthanasia and other medical decisions concerning the end of life. The treatment and health care of subjects who this initiative before the Italian and European 1. Health.of the elderlv. Report of a WHO Expert parliaments. If readers would like to support our Lancet, 338: 669-674 (1991). present with diabetes after the age of 65 years Committee. Geneva, World Health Organization, differ from that of middle-aged patients. 1989 (WHO Technical Report Series, No. 779). activity we should be pleased to hear from them. Although nutrient metabolism alters with aging, there are no separate diagnostic criteria as there Certainly there are different approaches to dying are for children. Moreover, the benefits of with dignity. We believe that a free and personal treating mild to moderate elevations of blood decision of the patients about the circumstances glucose concentrations or of intervening in Dying with dignity: of their dying is of fundamental importance. secondary complications like hyperlipidaemias illusion, hope or human right? If a patient prefers to die in hospital he should Holistic approach to health for all are not conclusive. receive our support to find an adequate place there; but if he expresses the wish to stay at SIR - The greatest improvements in health come SIR- We have read with interest your Round home it is then our task to assist him at home, from public health measures, environmental The following points should be taken into Table on "Dying with dignity" (World health account in the management of diabetes mellitus forum, Vol. 12, No.4, 1991). Based on our together with his family. Cancer patients in improvements, and changes in individual in the elderly. advanced stages experience a fundamental experience with the Bologna Eubiosia Project life-styles. The holistic concept of health covers conflict. They want to receive all possible care, human biology, personal behaviour (life-style), for advanced cancer patients (1), in which • Rigorous treatment of mild to moderate 6405 patients were treated free of charge at which public opinion leads them to believe is the psychosocial environment, community available only in a cancer hospital; on the other culture, the medical care system, and the hyperglycaemia in an asymptomatic patient is home between December 1985 and June 1992, not mandatory. we would like to add a few remarks. hand they want to stay at home with their physical environment (both natural and families. We believe the hospital-at-home man-made).

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