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Journal Volume 4 No 1 May 2001 EDITORIAL Issues relating to the retention of organs after hospital post mortem examination, and those concerning organ donation and transplant have been the subject of much discussion. The McLean report contains the findings and recommendations of a review group which looked at post mortem practice in Scotland, and which was set up in the wake of the scandals surrounding such practice at Alder Hey hospital. Bereaved relatives, especially parents, expressed their fears and concerns surrounding organ retention without proper information and consent. The first four contributions to this edition of the Journal arise out of this climate of discussion and debate regarding the retention and use of organs. Lynne Thomson reminds us that the gap between the supply of organs suitable for transplant, and the demand for such organs is an ever widening one, and she presents us with a case for a change in legislation in favour of 'presumed consent.' Peter Johnston tackles the complex issue of the management of death and bereavement in an acute setting, and in particular, the way in which the post mortem can be a valuable aspect of continuing care for patients and relatives through death and the bereavement process. His is a plea for information, education, partnership and openness regarding these difficult issues, to enable rebuilding public trust which has been shaken by recent publicity. Fred Coutts speaks of the role played by the chaplaincy department in responding to the anxieties of relatives and reflects on the deeper spiritual issues which lie behind them. Shirley Seabury speaks of her experience of parents' reactions to the loss of a child. Particularly poignant is her stress upon the perceived need of parents to protect their child, and how this need to protect, in life and in death, can lead to deep feelings of guilt over the death, and a reluctance to agree to post mortem. Looking over this edition, it seems that there is much that has to do with death. How do we handle it, both personally and professionally? How we can improve our practice in an acute setting? How do we work out our understanding of spirituality and spiritual care in the face of death? What can the modern novel can tell us about the attitudes of our society towards death? It may be that recent publicity raising the profile of death in hospital will have the positive effect of helping to chip away at the long conspiracy of silence, and lead to greater confidence and sensitivity in this area on the part of all those engaged in health care. Full Text (PDF Format) |
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CONTENTS DEVELOPING
THE APPROACH TO POSTMORTEM PRACTICE Pages 2-6 There is potential to improve the management of death and bereavement in acute hospitals and an opportunity to do so. The author suggests ways in which improvements might be brought forward, with particular reference to education of health care professionals and the public about the role and value of the postmortem. Reform of the consent process for autopsy to include the opportunity of involvement of pathologists at an early stage is proposed. The provision of the chance for relatives to receive feedback of postmortem data again with pathologist input is also suggested in tandem with the offer of bereavement counselling for grieving families. The potential value of the postmortem in managing bereavement should be studied. It is acknowledged that such intervention could be costly in resource terms, but if value can be discerned, it may well be worthwhile. Key Words: death, bereavement, postmortem, autopsy, necropsy, counselling, pathology Peter W Johnston is Consultant Pathologis, Department of Pathology Aberdeen Royal Infirmary Full Text (PDF Format) ORGAN
DONATION: IS A CHANGE TO LEGISLATION THE ANSWER? Pages 7-9 In 2000 the number of organ transplants performed fell by 3% while the waiting list numbers rose by 2%. The human consequence of these statistics is that because of the shortage of organs more people who are in need of a transplant are dying. There is no one single reason to why this is happening with the result that the solution may be complex. One initiative to improve the current situation with regards organ donation is a change to legislation, to move from the current system where-by the views of the next of kin are sought prior to donation, to one where consent will be presumed unless the deceased has registered an objection during their lifetime. Key Words: Legislation, opt-in, opt-out, organ donation, organ supply, transplantation Lynne Thomson is Transplant Co-ordinator Western Infirmary, Glasgow Full Text (PDF Format) ORGAN RETENTION: HELPLINE EXPERIENCES Fred Coutts and Gerogina Nelson Pages 10-13 The article arises out of an interview with Fred Coutts from the chaplaincy department of the Grampian University Hospitals, which includes Aberdeen Royal Infirmary, Aberdeen Maternity Hospital and the Royal Aberdeen Children's Hospital. Fred describes a recent period of crisis in the life of the hospital, and how during this period, the chaplaincy department was able to provide a service to both hospital and community. By the nature of their training and day to day work, the chaplains were perhaps uniquely well able to provide this service. Key Words: Helpline, organ retention, pastoral care, pathologists, spiritual shift Fred Coutts is a full-time chaplain with
Grampian University Hospitals NHS Trust in
Aberdeen. Full Text (PDF Format) WORKING
WITH BEREAVED PARENTS Pages 14-15 Shirley Seabury is a bereavement counsellor working within West Lothian Healthcare NHS Trust. She has extensive experience with parents whose baby has been stillborn or has died shortly after birth. In the following article, Shirley reflects upon her role, and adds her own perspective in the light of the publicity surrounding the retention of organs at Alderhey, and in Scotland, the McLean Report. Key Words: AlderHey, bereavement, counselling, distress, nurture, postmortem Shirley Seabury
is a bereavement counsellor working within West Lothian Healthcare NHS
Trust Full Text (PDF Format) THE
GOOD DEATH AND THE MODERN NOVEL Pages 16-20 This paper reflects whether contemporary fiction can be used to establish and refine any modern idea of a good death. It defines a good death initially as one which is non-violent and sums up a whole life. It tests this against a series of examples, and looks at notions of preparedness and aptness, as well as some anxieties. A fuller reading of one novel suggest a good death entails additionally finding an appropriate language, the telling and ending of stories and the ordering of loves. Key words: Death, fiction, anxieties, preparedness, language, stories Kate Durie is an Associate Lecturer with the Open University and teaches courses in literature part-time at Stirling University. Full Text (PDF Format) A
LEAP OF FAITH? ENABLING HOSPICE STAFF TO MEET THE SPIRITUAL NEEDS OF
PATIENTS Pages 21-25 This article is based on research undertaken for the degree of Doctor of Ministry. Its focus is the investigation of two phenomena raised by members of hospice staff as impediments to the delivery of spiritual care. These are the problems of discerning the spiritual aspect of interventions with patients, and the apprehension staff feel in being faced with the prospect of meeting those needs for which they consider themselves unprepared. These two phenomena were tested by sharing with staff, six pastoral conversations and recording the degree to which they were able to pick up the spiritual content of the conversation. The research discovered that staff, although highly motivated, do not always have the confidence or the knowledge to address the spiritual needs of patients at an appropriate level of sophistication. Key words: spiritual care; staff; hospice; training; Setting the Scene Derek Brown is full-time chaplain at Raigmore Hospital and Highland Hospice, Inverness. Full Text (PDF Format) CHAPLAINCY AND SPIRITUAL
CARE IN A CHILDREN'S HOSPICE Pages 26-28 Kay Gilchrist, chaplain at Scotland's children's hospice,
Rachel House, gives us a frank and personal insight into chaplaincy
and spiritual care in this specialised field and setting. Reflecting
on the atmosphere in the hospice, her own personal gifts, experiences
and development, and the different needs of patients and their families,
we are given a unique look into this special place and experience. Holding
to a traditional understanding of faith in the face of the challenging
questions of children is not easy. We discover each child needs an individual
response, and often one that is personal and innovative Kay Gilchrist is full-time chaplain at Rachel House, Kinross Full Text (PDF Format) BOOK REVIEWS Pages 29-36 Counselling Skills in Palliative Care Full Text (PDF Format) POETRY Temples of Truth I'd like to see a renovated morgue? Daniel Grossoehm |
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THE ORERE SOURCE Abstracts from Pastoral Care and other health Care Journals. Pages 37-43 Rev
W Noel Brown Full Text (PDF Format) |
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