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Death wishes of the very old 1
Published in Govert den Hartogh, What Kind of Death, 2023
In some cases this meaning is evident. If a person has a strong and continuous sense of suffocation because of lack of breath, you need not to know anything else about her to understand that she is in a state of extreme suffering. But in the majority of cases you can only understand the nature and severity of the suffering against the background of the patient's personality, biography and values. That is the basic task which the Dutch euthanasia law requires to be performed in all cases of euthanasia, both by the doctors involved and the colleagues they consult. Doctors should be equipped to perform that task, and many of them are.23 The very distinction between ‘somatic’ and ‘existential’ suffering is misleading because it doesn't distinguish between the cause and the nature of the suffering.24 In the case of old people with death wishes that are related to their age, the cause will often be physical illness, but suffering, by its nature, is always existential.
Other Asphyxial Deaths
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Suffocation is a broad term that includes deaths caused by vitiated atmosphere, smothering and sometimes choking, which are associated with oxygen deprivation. Suffocation is one of the broad classes of asphyxial deaths in the various classifications attempted by different authors, alongside strangulation and drowning. Smothering is included under the broad term of suffocation. Smothering has been defined as an obstruction at the level of the nose and mouth or as an obstruction of the upper airways or obstruction of the external airways by different authors. While Knight B defines it as mechanical occlusion of the mouth and nose, the widely accepted and unified newer classification of asphyxia given by Sauvageau describes it as an obstruction of the air passage above the level of the epiglottis, which includes the nose, mouth and pharynx. However, since the usage of this term for blockage inside the oral cavity and pharynx creates confusion with the term ‘gagging’, we suggest that the definition of smothering be limited to mechanical obstruction of external respiratory orifices, i.e., the mouth and nose only. This should clear any terminology-related confusion created by the use of more generalized anatomical terms such as ‘airways’ or ‘respiratory passages’. Smothering can be included under the broader classification of suffocation as here there is no confusion in the older as well as newer classifications.
Asphyxia
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
Asphyxia from the exclusion or displacement of ambient O2 by other gases has been documented.1 This includes CO2, which is encountered in manholes, wells, and silos. The exclusion or displacement of ambient O2 results in death from suffocation. Entrapment in confined spaces, such as car trunks or refrigerators, in which breathing consumes O2 while producing CO2, will lead to asphyxia and death by suffocation. Similarly, the placement of one’s head inside of a plastic bag as a suicidal gesture or as an aid to becoming deliberately intoxicated via aerosolized inhalants will lead to the accumulation of CO2 and asphyxia. The inhalants alone may contain solvents that are directly toxic to the heart, with the potential for causing sudden death. Accidental asphyxia due to the gradual accumulation of CO2 via rebreathing of exhaled air in a case of autoerotic submersion in a lake (aqua-eroticum) has been reported.15
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis
Published in Expert Review of Respiratory Medicine, 2023
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
Central airway obstruction (CAO) is defined as airway stenosis involving the trachea, main bronchus, bronchus intermedius, or lobar bronchus [1,2]. It is a life-threatening disease; if untreated, most of the patients may die from suffocation. The etiologies of CAO can be divided into malignant and nonmalignant types. Malignant CAO is often caused by the extension of adjacent tumors, such as bronchogenic carcinoma, esophageal and thyroid carcinoma [3,4]. The nonmalignant etiologies include airway trauma, prolonged endotracheal intubation, tracheostomy, benign airway tumors, hyperplasia of granulation tissue after surgery, and tracheobronchomalacia [5]. Nonmalignant CAO can also be caused by inflammatory diseases, including sarcoidosis, amyloidosis, and granulomatosis with polyangiitis [5]. Post tuberculosis (TB) infection can also result in CAO [6,7], with tuberculosis cases increasing in incidence worldwide [8].
Alzheimer’s Disease, Grieving Process, and Art Therapy: Case Study
Published in Art Therapy, 2023
In the first session, Mrs. P. mentioned that when she is left alone at home, she finds it difficult to breathe and has a sensation of suffocation. Direct breathing exercises alleviated her somatic complaint. To address dispersion and apathy, olfactory resources (jasmine and orange blossom) were used as components of a game, hidden in boxes and applied as stimuli to find out what images these smells could generate in her and how she could represent them. The two scents reminded Mrs. P. of her villa, which she described specific aspects of the house and drew each element on the paper (Figure 1A). However, when Mrs. P. distanced herself from the artwork she had difficulty in recognizing what she had drawn. When she smelled the boxes she remembered again. “Imagine what my head looks like,” she said, because she feels that her thinking is confusing, and she finds it is hard to remember anything without clues or aids. For the following sessions, pre-structured material such as prefabricated cutouts and cardboard of different colors were used, so that she could start creating and adding different elements. Mrs. P. would choose a figure (already cut out), place it on the support and tell a story, followed by drawings made with markers (Figure 1B).
Traumatic spinal cord injury mortality from 2006 to 2016 in China
Published in The Journal of Spinal Cord Medicine, 2021
Bin Li, Jinlei Qi, Peixia Cheng, Peng Yin, Guoqing Hu, Lijun Wang, Yunning Liu, Jiangmei Liu, Xinying Zeng, Jianzhong Hu, Maigeng Zhou
Notably, the overall age-standardized TSCI mortality rate significantly increased by 64% between 2006 and 2016. Similar increases in the same time period were also observed for unintentional suffocation mortality among children aged 1–4 years.14 The recent increase likely reflects the threat from growing motorization over the country and much-lagged injury prevention. According to the official statistics, the number of motor vehicles increased from 37 million in 2006 to 186 million in 2016 in China.15 However, the China government has not paid enough attention to injury prevention and no specific agency is assigned to take charge of supervising and coordinating injuries prevention efforts, severely restricted the national investment in injury research.16 In the future, it is necessary to strengthen the intervention in this area, especially the intervention in road traffic accidents and falls. The previous study suggested that higher TSCI mortality among males might be linked to high likelihood of taking on high-risk occupations, such as aloft work employees, construction workers, truck drivers and others.17 Relatively higher TSCI mortality in a rural area can be partially explained poor first aid and hospital treatment compared to an urban area.18 The highest TSCI mortality is mainly because of declines in physical and cognitive functions due to aging and having chronic diseases.19