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Olick, Rihito KimuraJan T. Most ALS patients ultimately die of respiratory failure, often after reaching a decision not to start or to discontinue ventilatory support. This paper offers a cross-cultural perspective on ethical and socio-cultural issues in advance care planning for ALS patients, with particular emphasis on the role of advance directives for health care.
We examine these questions in the different cultural, legal, medical and ethical traditions of Japan, Germany and the U. Some aspects of the discussion may be generalizable to other late onset degenerative conditions.
The ethical issues raised by advance care planning with ALS patients are especially relevant to other conditions also often characterized by retention of mental capacity over the course of long-term physical deterioration, such as multiple sclerosis MS and progressive muscular dystrophy.
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It does not diminish, however, the relevance of advance directives nor the broader importance of advance planning for end-of-life decisions.
Discussion of advance directives fosters articulation of a more informed and comprehensive treatment plan that includes the patient's own choices for end-of-life care. In addition to promoting self-determination and control over the dying process, advance directives alleviate emotional and psychological burdens of family members who may otherwise face the choice of ventilatory support without knowing the patient's wishes; decrease physician uncertainty about patient's wishes; and offer greater assurance of compliance with the patient's wishes by health care professionals.
With ALS patients, participation in decisions can be impaired or impossible despite intact cognitive abilities, for example when speech ability is lost and communication assistance devices prove unavailable or inadequate, or when the patient suffers from the totally locked-in syndrome "TLS" in an advance stage of the disease.
As illustrated by the Leach case, 2 in which an ALS patient was hospitalized after suffering a stroke at home, the ALS patient is also susceptible to other illnesses and conditions that can rob him or her of the ability to decide.
For all of these reasons advance directives can play a major role in planning ahead for important end-of-life decisions for the ALS patient. The clinical manifestations are progressive motor weakness and muscle atrophy.
Capacities for sensation and awareness remain intact, and patients ordinarily retain intellectual ability and mental competence absent complicating conditions until very late in the course of illness.
Degenerative loss of motor neurons in the spinal cord and of muscle control generally leads to quadriplegia and dependence on others for support of daily living activities. ALS is often marked by gradual loss of the ability to speak and swallow caused by progressive motor weakness of throat and facial muscles.
The median duration of this invariably fatal disease from diagnosis to death is 4 years, but there are reported cases of some patients living for up to two decades after initial diagnosis.
Progression of the disease ordinarily is at a gradual and steady rate. Men are affected by ALS somewhat more frequently than women, with peak onset occurring for most patients in their 50's and 60's. The cause and pathogenesis of ALS are not known; there is no specific cure or treatment.
While early deterioration of respiratory capacity is invariably gradual, an accelerated decline occurs during the 12 to 15 months preceding death. A care plan is of especial importance for ALS patients because of the long clinical course of illness from time of diagnosis, during which time many treatment choices will need to be made.
A critical concern for the ALS patient is to maintain control and independence - to continue to pursue life's activities both large and small to the greatest extent possible. Feeling in charge of one's own life is not only valued for its own sake, it can have a drastic impact on psychological well-being and can prolong survival in ALS patients.Cross cultural management involves managing work teams in ways that considers the differences in cultures, practices and preferences of consumers in a global or international business context.
Many businesses have to learn to modify or adapt their approaches in order to compete on a level in fields. Chapter 13 Leadership and change management: a cross-cultural perspective from Russia Natalia Vinokurova, Vyacheslav Boltrukevich, Alexander Naumov Chapter 14 .
Cross‐cultural management is a matter of perspective.
It would useful if some further discussion leads scholars to a more complete list of perspectives and metaphors associated with these perspectives.
A perspective on gender in management: The need for strategic cross-cultural scholarship on women in management and leadership Culture and context matter: gender in international business and management. Culture is often at the root of communication challenges.
Exploring historical experiences and the ways in which various cultural groups have related to each other is key to opening channels for cross-cultural communication.
Becoming more aware of cultural differences, as well as exploring cultural similarities, can help you communicate with others more effectively. Cross Cultural Management: A Perspective in China Name Management XXX Cross-cultural Management Instructor Date Cross Cultural Management 2 Abstract A significant amount of research that has been conducted in reference to cross-cultural issues in China.
It shows the current practices on cross-cultural management in Chinese organizations; and.