The author, a consultant psychotherapist who works with dying patients in a National Health Service (NHS) hospital, argues that the moral issue is not simply whether or not to tell cancer patients the truth, but more importantly how to do so. Lies and the bald unprepared-for truth may both be damaging. Time and trouble is needed to understand patients and help them understand their situation. Dr Goldie warns that putting oneself into the patient's shoes, as doctors so often do, is the best way ofnot knowing what another feels. Such misunderstanding may lead to medical decisions based on 'nothing more than fantasiesuninspired guesses about what other people think and feel. It is the equivalent ofprescribing for patients without examination'. The question whether or not to tell a patient the truth usually arises in connection with cancer. One would expect it to arise with other diseases but it does not do so. There does not appear to be the same debate about telling patients they have disseminated sclerosis, or coronary disease as there is with cancer. The issue, therefore, is not simply a matter of telling the truth it is a matter of telling the truth in one circumstance and not in another. Thus what the word 'cancer' signifies to the patient is supposed to influence the doctor in his decision to lie about the diagnosis. In fact I believe the decision is more influenced by the doctor's own feelings about cancer than by the patient's. Virtually all patients attending for diagnostic, exploratory, or other procedures, in the early stages of any malignancy, have in mind the possibility of cancer. The doctor's decision, therefore, is not whether to tell the patient the truth, or to deny it, but whether to play out a charade, with the patient, of normal life and prospects, in the presence ofincontrovertible symptoms and signs of the growing cancer. The charade may include other players; a surgeon may tell a spouse not to use the word cancer to the patient and urge a pretence that it is something else by using words like, 'lump', 'ulcer',
SUMMARY Serial studies were carried out on the EEG and sleep rhythms of 24 short‐gestation and small for‐dates babies. A regular cyclical alternation of eye movement sleep with non eye‐movement sleep was identifiable in all short gestation babies studied. The EEG was periodic in REM sleep up to 32/52 total age, and was continuous thereafter; in non‐REM sleep the EEG was always periodic, but the periodicity became regular at 36 weeks total age. ‘Slow waves’, (1–3 c.p.s.), ‘intermediate slow waves’ (4–6 c.p.s.), and ‘fast activity’ (14–24 c.p.s.), disappeared from the EEG in REM sleep at 34 weeks, but persisted for longer in non‐REM sleep. ‘Frontal humps’ and a period of marked flattening following non‐REM sleep appeared in the EEG during REM sleep at 36 weeks. Vertex sharp waves appeared during non‐REM sleep at 36 weeks. RÉSUMÉ Développement des rythmes innés de sommeil chez les enfants nés avant terme Des études en série ont été entreprises sur les EEG et les rythmes de sommeil d'enfants nés avant terme. Une succession cyclique régulière de sommeil avec mouvements oculaires et de sommeil sans mouvement oculaire a pu être observés chez tous les bébés nés avant terme étudiés. L'EEG est périodique durant le sommeil avec mouvement oculaire jusqu'à 32 semaines d'âge total et est ensuite continu. Dans le sommeil sans mouvement oculaire, l'EEG est toujours périodique mais la périodicité devient régulière à 36 semaines d'âge total. Les ‘ondes lentes’ (1 à 3 c.p.s.) les ‘ondes intermédiaires’ (4 à 6 c.p.s.) et l' ‘activité rapide’ (14 à 24 c.p.s.) disparaissent de l'EEG durant le sommeil à mouvement oculaire à 34 semaines d'âge total mais persiste plus longtemps dans le sommeil sans mouvement oculaire. Des ‘bases frontales’ et une période d'aplatissement accentuéà la suite du sommeil sans mouvement oculaire apparaissent à l'EEG durant le sommeil avec movement oculaire à 35 semaines d'âge total; des ondes pointues au niveau du vertex apparaissent durant le sommeil sans mouvement oculaire à 36 semaines d'âge total. ZUSAMENFASSUNG Die Entwicklung eines angeborenen Schlafrhythmus bei frühgeborenen Kindern Über das EEG und den Schlafrhythmus frühgeborener Kinder wurden Verlaufsuntersuchungen angestellt. Ein regelmäßiger zyklischer Wechsel von Augen‐Bewegungs‐Schlaf und Nicht‐Augen‐Bewegungs‐Schlaf fand sich bei allen untersuchten frühgeborenen Kindern. Das EEG war beim RAB‐Schlaf bis zum Alter von 32/52 periodisch und danach gleichbleibend; beim Nicht‐RAB‐Schlaf waren die EEGS immer periodisch, aber die Perioden wurden im Alter von 36/52 regelmäßig. ‘Langsame Wellen’ (1–3 c.p.s.), ‘Zwischenwellen’ (4–6 c.p.s.) und ‘schnelle Aktivität’ (14–24 c.p.s.) verschwanden beim RAB‐Schlaf mit 34/52 aus dem EEG, hielten jedoch beim Nicht RAB‐Schlaf länger an. RESUMEN El desarrollo de los ritmos de sue no innatos en lactantes de gestatión corta Se realizaron estudios seriados del EEG y ritmos de sueño en niños de corta gestatión. En todos los casos estudiados fue identificable una alternancia cíclica regular del movimiento ocular durante e...
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