【正文】 ve more consciously.Get in touch with our genuine feelings and emotions.Come to terms with the toxic emotionsUnit6 In the past, most people died at home. But now, more and more people are cared in hospitals and nursing homes at their end of life, which of course brings a new set of questions to consider.Sixtyfour years old with a history of congestive heart failureDeciding to do everything medically possible to extend his lifeAvailability of aroundtheclock medical services and a full range of treatment choices, tests, and other medical care Relaxed visiting hours, and personal items from home Availability of aroundtheclock medical resources, including doctors, nurses, and facility.Taking on a job which is big physically, emotionally, and financiallyHiring a home nurse for additional helpArranging for services (such as visiting nurses) and special equipment (like a hospital bed or bedside mode)Health insurancePlanning by a professional, such as a hospital discharge plaimer or a social workerHelp from local governmental agenciesDoctor39。s supervision at homeTraditionally, it is only about symptom care.Recently, it is a prehensive approach to improving the quality of life for people who are living with potentially fatal diseases.Stopping treatment specifically aimed at curing an illness equals discontinuing all treatment.Choosing a hospice is a permanent decision.Unit7A dying patientDecision whether to withdraw lifesupport machines and medication and start fort measuresThe family39。s refusal to make any decision or withdraw any treatmentsThe doctor as exclusive decisionmakerThe patient as participant with little say in the final choiceRespect for the patient, especially the patient s autonomyPatientcentered careThe patient as decisionmaker based on the information provided by the doctorPatients are forced to make decisions they never want to.Patients, at least a large majority of them, prefer their doctors to make final decisions.Shifting responsibility of decisionmaking to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain. Doctors are very much cautious about mitting some kind of ethical transgression.Shouldering responsibility together with the patient may be better than having the patient make decisions on their own.Balancing between paternalism and respect for patients autonomy constitutes a large part of medical practice.Unit8Research: An activity to test hypothesis, to permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledgePractice: Interventions solely to enhance the wellbeing of an individual patient or client and that have a reasonable expectation of successBlurred distinction: 187。 Cooccurrence of research and practice like in research designed to evaluate a therapy 187。 Notable departures from standard practice being called “experimental” with the terms “experimental” and “research” carelessly definedAutonomy： Individuals treated as autonomous agents .Protection:Persons with diminished autonomy entitled to protectionA case in point:Prisoners involved in research 3“Do no harm” as the primary principle Maximization of possible benefits and minimization of possible harms . Balance between benefits and potential risks involved in every step of seeding the benefits“Do no harm” as a fundamental principle of medical ethicsExtension of it to the realm of research by Claude BernardBenefits and risks as a set “duet” in both medical practice and researchUnreasonable denial of entitled benefit and unduly imposed burden：Enrolment of patients in new drug trial: Who should be enrolled and who should not?Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status Definition:The opportunity to choose what shall or shall not happen to themApplication:187。 A process rather than signing a written form 187。 Adequate information as the premise 187。 A wellinformed decision as the expected resultRequirements for consent as entailed by the principle of respect for personsRisk/benefit assessment as entailed by the principle of beneficenceMore requirements of fairness as entailed by the principle of justice: 187。 At the individual level: fairness 187。 At the social level: distinction between classes