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In this paper, we propose a new non-parametric test for equality of distributions. The test is based on the recently introduced measure of (niche) overlap and its rank-based estimator. As the estimator makes only one basic assumption on the underlying distribution, namely continuity, the test is universal applicable in contrast to many tests that are restricted to only specific scenarios. By construction, the new test is capable of detecting differences in location and scale. It thus complements the large class of rank-based tests that are constructed based on the non-parametric relative effect. In simulations this new test procedure obtained higher power and lower type I error compared to two common tests in several settings. The new procedure shows overall good performance. Together with its simplicity, this test can be used broadly. [ABSTRACT FROM AUTHOR]

These narratives provide intimate descriptions of the challenges, frustrations, and sometimes, the satisfaction of caring for a family member with dementia. They are presented by twelve individuals who want us to understand and possibly learn from their lived experiences. At the beginning of their journey, most describe a slow awareness that "something is seriously wrong." During the middle stage, their narratives are filled with examples of conflict and frustration as the authors try to respond with patience to behavior that "makes no sense." Finally, most learn to forgive themselves and accept 'the new normal' of this person, or their death. For some, the end of their journey is filled with regret and guilt, while others find acceptance and peace. We are privileged to be immersed in these stories, as such honest descriptions are rarely shared with 'outsiders.' [ABSTRACT FROM AUTHOR]

To follow up on research conducted in several countries, in this paper, we look at the dilemmas middle-class parents face of being "good parents" by choosing the "best" school with a milieu-related environment for their child versus being "good citizens" by choosing a "local" public school with a large proportion of students from a working-class or migrant background. Analyzing semi-structured interviews with parents, the paper explores whether and how parents in Germany's capital city of Berlin refer to this dilemma concerning primary school choice and how they resolve it and justify their decision. The parents interviewed applied strategies in deciding to be "good parents" or "good citizens" or at least to make it easier to solve the dilemma. All the strategies presented in other studies can be found in our sample as well. In addition, we identified two more parental strategies: the strategy of downward comparison and the strategy of choosing a private school. It is notable that the perceived proportion of children with a migrant background in the neighborhood played a major role in relation to the dilemma and the strategies chosen. [ABSTRACT FROM AUTHOR]

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The article presents a case of dementia patient named Gertrude was 72 and retired for 2 years before she completed two advance directives. It mentions she might have known that people with advanced dementia are dependent upon others for hand feeding in the final months or years of this stage of dementia; and also mentions in advance directives that limit oral feeding will include very specific clinical triggers to inform caregivers.

The decision concerning voluntarily stopping eating and drinking (VSED) is increasingly discussed by health care professionals as an appropriate palliative option for decisionally capable, suffering patients who wish to hasten their deaths. Most palliative care clinicians consider VSED an ethical and legally supported choice, and some argue that there is therapeutic value in discussing this option with patients when suffering is intolerable and the desire to control the circumstances of dying is clear and enduring. Others resist informing patients about this option. This article presents a case of a decisionally capable, terminally ill patient who requests hospice support for her decision to hasten her death by VSED. [ABSTRACT FROM AUTHOR]

There is an acknowledged difficulty in distinguishing between some morally and legally accepted acts that hasten dying, such as refusing life-sustaining treatment, and other acts that also hasten dying that are labeled as acts of “suicide.” Recent empirical findings suggest that most terminally ill and suffering patients who voluntarily chose to stop eating and drinking as a means to hasten their dying generally experienced a “good” death. This paper explores the moral and legal status of a decision to stop eating and drinking as a means to hasten dying that is voluntarily chosen by a competent, terminally ill and suffering patient. The option of voluntarily forgoing food and fluid will be compared to other end-of-life clinical practices known to hasten dying, with emphasis on the issue of whether such practices can or should be distinguished from suicide. [ABSTRACT FROM AUTHOR]

What would Terri Schiavo have wanted? That remains an unanswered question for many who followed the media frenzy that attended the extraordinary court and legislative battles that preceded her death 13 days after her feeding tube was removed for the last time. What would she have directed her physicians to do if she had "miraculously" regained capacity and awareness of the consequences of her cardiac arrest that left her in a persistent vegetative state? Who would she have wanted to make that decision for her if she were unable to do so? How are we to understand the meaning of statements that she purportedly made about life-sustaining treatments approximately 20 years ago, and how can we apply them to the current situation? This article reflects on those questions from the perspective of two small exploratory studies. These studies considered the meanings and interpretation of statements by terminally ill patients concerning desire for hastened death and the relevance of previously made statements to their current clinical situation. [ABSTRACT FROM AUTHOR]

Little is known about how American nurses understand and respond to requests made by decisionally capable patients for assistance in dying. This article Is based on a broader qualitative study first reported elsewhere (Schwarz, 2003). The study used phenomenological interpretation and analysis of stories told by 10 nurses who worked In home hospice, critical care, and HIV/AIDS care settings. Persistent requests for assistance in dying were relatively uncommon, but when heard, participants provided the following responses: refusing assistance, administering palliative drugs that might secondarily hasten dying, tacitly permitting and not Interfering with patient or family pinto hasten death, and actively providing direct assistance in dying. Nurses' responses were context-driven; they did not seek guidance from professional codes of ethics or colleagues. Secrecy and collusion were routinely practiced. Few participants unequivocally agreed or refused to help patients die; most struggled to find morally and legally acceptable ways to help patients die well. Regardless of how they responded, nurses who believed they had hastened death described feelings of guilt and moral distress. Health-care professionals who provide care for symptomatic dying patients need opportunities to meet with supportive colleagues, to share the experience of troubling cases and of moral conflict, and to be supported and hoard in a 'safe' environment. [ABSTRACT FROM AUTHOR]

Purpose: To explore how nurses experience and respond to patients' requests for assistance in dying (AID). Design and Methods: A phenomenological study of 10 self-selected nurses. Findings: Four major themes: Being Open to Hear and Hearing; Interpreting and Responding to the Meaning; Responding to Persistent Requests for AID, and Reflections. When faced with persistent requests for AID, participants provided a continuum of interventions: refusal, providing palliative care that might secondarily hasten dying, respecting and not interfering with patients' or families' plans to hasten dying, and providing varying types and degrees of direct AID. Their responses were context-driven rather than rule-mandated, and they drew a distinction between secondarily hastening and directly causing death. Conclusions: Few nurses in this study unequivocally agreed or refused to directly help a patient die. Most struggled alone and in silence to find a morally and legally acceptable way to help patients who persisted in requesting AID. Regardless of how they responded, many described feelings of conflict, guilt, and moral distress. [ABSTRACT FROM AUTHOR]