Day 2 :
The Center for Counseling and Sexual Health, Florida
Keynote: Understanding Sex and Sexuality in Palliative Care; Establishing a Dialogue at the End of Life
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Michael Ian Rothenberg, Ph.D, LCSW is a Board Certified Clinical Sexologist, Certified Sex Therapist, Psychotherapist and the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park, Florida. As a sexuality educator, Dr. Rothenberg has held a long term faculty position, in Orlando, Florida, at the University of Central Florida (UCF), School of Social Work, where he developed the curriculum in Human Sexuality and taught courses on human sexuality and sexual behavior. Dr. Rothenberg, a former Hospice Social Worker, credited with developing the Sexological sub-field of Thanatological Clinical Sexology (the study of sexuality, death and dying), has published and been quoted in numerous articles relating to human sexuality and lectures, both nationally and internationally, at universities, hospitals and hospices, on topics related to human sexuality, sexual behavior and sexual health.
Introduction: Human beings are sexual beings from birth until death. This presentation explores sex and sexuality at the end of life and the importance of establishing a dialogue between patients and clinicians as an integral part of end of life care. Objectives: To identify and understand barriers and challenges in discussing sex and sexuality at the end of life and establish a methodology for better communication.Methods: A qualitative methodological approach was utilized and the resultant data will be presented as case histories gathered in the context of clinical sexology consultations.Results: As discomfort and physical pain, at the end of life, can be controlled through the proper use of medication, psychological and emotional distress, directly and indirectly, related to sex and sexuality, can be ameliorated through specific conversation and dialogue. Conclusion: This presentation hopes to raise important questions about the palliative care professional's responsibility regarding the understanding of sexuality for individuals in the end of life stage as well as illustrate how to begin to engage in needed discussions on sex and sexuality.
Geisinger Medical Center, United States
Dr. Mellar P. Davis, MD, FCCP FAAHPM is a member of the Palliative Care Department, and Section Head, Geisinger Medical System Danville, PA. He has been a member of the Geisinger Medical Staff since August 2016. In his role as Section Head, Dr Davis is responsible for developing palliative care services throughout the Geisinger Medical System including outpatient and inpatient services. In addition, Dr Davis works with the Geisinger Hospice Services to develop and coordinate care within the central region.
Palliative care has emerged as an approach that specifically addresses gaps inherent in a disease-centered approach to care. Early palliative care has been promoted as the optimal approach to care for individuals with advanced illnesses. A systematic review of trials found 15 RCTs (randomized controlled trials) of early outpatient, 13 RCTs of home palliative care and 7 systematic reviews(1). A subset of RCTs have demonstrated improved symptoms, quality of life, reduced aggressive care at the end of life, increased advanced directives, reduced hospital stays, improved caregiver burden and quality of life, reduced costs and improved family satisfaction. Yet RCT have also demonstrated no benefits to palliative care in the same outcomes. Why the difference? The term “early” and “standard of care” are poorly defined and subject to regional practices. Imbalances and attrition between groups contributed to differences in outcomes. Many RCTs lacked power calculations or were under powered for outcome measures. Outcomes were skewed yet parametric statistics were done giving weight to outliers in the results. Timing of assessment for outcomes in some trials was too early or late to see full benefits. Intention to treat analysis was often not done; outcomes were based on treatment analysis. Financial assessment was based exclusively on costs or charges centered on medical resource utilization rather than family expenditures. Multiple models of palliative care were used in these RCTs. This workshop/concurrent session will review the evidence for early palliative care and the differences and weaknesses in trials which may have contributed to divergent outcomes.
College of Philosophy and Theology, Germany
Dr Baranzke is a theological ethicist and often engaged in interdisciplinary research groups. In her ethical research she questions central, mostly traditional ethical terms (sanctity of life, dignity, reverence for life, person etc.) in life science ethical debates in the light of the concepts’ history in order to deconstruct misunderstandings in present human and non-human bioethical debates. At present she is a member of a research group in nursing ethics.
For about five decades the phrase “sanctity-of-life“ has been part of the Anglo-American biomedical ethical discussion especially about abortion and euthanasia. Nevertheless, the concept’s origin and meaning are unclear. Much controversy assumes that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. Therefore, the well-known bioethicists Peter Singer and Helga Kuhse have proclaimed the necessity to replace the traditional ethics of the sanctity of human life-doctrine by a new ethics. They have stimulated a vivid sanctity vs. quality of life-debate.
In 2012, I have offered an analysis of the religious and philosophical history of the idea of “sanctity-of-life.” Drawing on biblical texts and interpretations as well as on Kant’s secularization of the concept, I have argued that “sanctity” has been misunderstood as an ontological feature of biological human life. Instead, I have traced back the term to the virtue-ethical tradition in ancient and medieval times, which conceives sanctification as a personal achievement through one’s own actions. On this basis a fresh start can be taken by asking, which consequences this kind of conception of the term may have with regard to hospice and palliative care in comparison to the utilitarian approaches of Singer and Kuhse.