Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer... more Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer cases over the next 20 years, and the biggest rates of increase will occur in the developing world. Owing to technical advances in the care of critical illness, as it is the case in elderly people with advanced cancer, physicians, patients and families are often confronted with ambiguous circumstances in which medical advances may inadvertently prolong suffering and the dying process rather than bring healing and recovery. In this review of the ethical issues confronting physicians who care for patients with advanced life-limiting illnesses like cancer, a philosophical debate continues in the medical community regarding the rightness or wrongness of certain actions (e.g. physician-assisted death, euthanasia), while at the same time there is a strong desire to find a common ground for moral discourse that could guide medical decision-making in this difficult period in the lives of our patients. We will discuss how a good palliative care can be an alternative to these ethical dilemmas. Although some issues (e.g. the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, no malfeasance, beneficence, autonomy and justice. Thus, the physician's primary commitment must always be the patient's welfare and best interests, whether the physician is treating illness or helping patients to cope with illness, disability and death. A key skill here is the communication of bad news and to negotiate a treatment plan that is acceptable to the patient, the family and the healthcare team. Attention to psychosocial issues demands involvement of the patients and their families as partners. Physicians should be sensitive to the range of psychosocial distress and social disruption common to dying patients and their families. Spiritual issues often come to the fore. An interdisciplinary healthcare team can help in these areas. The goals of this review are to raise the awareness of doctors, nurses and other members of the healthcare team to the important ethical issues that must be addressed in providing medical care to elderly patients with advanced cancer; and also to encourage members of the healthcare team to take the ethical issues seriously so that we can improve the circumstances of a vulnerable group of patients-the elderly patients with cancer.
We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid t... more We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid tumor with silicone implants. The patient had a stage III adenocarcinoma (T4 N1 M0) at diagnosis; a modified radical mastectomy was done, followed by radiotherapy and chemotherapy. Later on, Tamoxifen was prescribed (positive hormone receptors). Reviewing the literature about this subject in a context of a moratorium of the Food and Drug Administration (FDA) in the United States recommending suspension of silicone breast implantation, we can propose several conclusions: Previous and recent studies did not show any direct relation between cancer and silicone implants for augmentation mammoplasty; on the contrary, a lower incidence of breast cancer is noted. Breast cancer incidence with silicone implants seems to be higher with reconstructive mammoplasty after mastectomy for benign disease (fibrocystic disease, dysplasia, phylloid tumor), or prophylactic reason, or malignancy (carcinoma in situ, lobular and multifocal carcinoma, early breast cancer...). This can be related to recurrence or cancer development on residual breast tissue. Breast cancer with silicone implants is of poorer prognosis because of the later diagnosis of the disease.
L’incidence du cancer et la mortalité par cette maladie sont en nette progression dans le monde, ... more L’incidence du cancer et la mortalité par cette maladie sont en nette progression dans le monde, et plus particulièrement dans les pays en voie de développement, incluant les pays du Moyen-Orient et de l’Afrique du Nord. Les barrières au contrôle du cancer dans ces régions sont d’ordre économique et organisationnel mais aussi dues aux causes culturelles associées à l’ignorance, aux mythes et aux tabous liés au cancer. Il existe plusieurs raisons qui ont stigmatisé le cancer ; la plupart des personnes dans ces régions continuent à considérer que le cancer est une maladie fatale à tous les coups, qu’il peut être contagieux. Il est même parfois considéré comme une punition. Les paroles de patients qui évoquent ces stigmates et ces perceptions sont rapportées. Le rôle de la famille et de la spiritualité est évoqué. Ces mythes et tabous sont un continuel défi pour le contrôle du cancer : ils entraînent un effet contraire aux efforts de sensibilisation et de prévention du cancer. D’où l’objectif n° 5 de la Déclaration universelle de l’UICC de faire disparaître les effets néfastes des mythes et des stigmates. Après avoir passé en revue plusieurs exemples de mythes et de tabous rencontrés dans la pratique, nous rapportons quelques leçons apprises et utiles dans la lutte contre le cancer dans les pays du Moyen- Orient et du nord de l’Afrique.
End-of-life care is an important aspect of medical practice. Individual physicians and the medica... more End-of-life care is an important aspect of medical practice. Individual physicians and the medical community must be committed to the compassionate and competent provision of care to dying patients and their families. Patients rightfully expect their physicians to care for them and provide them with medical assistance as they are dying. To care properly for patients near the end of life, the physician must understand that palliative care entails addressing physical, psychosocial, and spiritual needs and that patients may at times require palliative treatment in an acute care context. To provide palliative care, the physician must be up to date on the proper use of opioids and the legality and propriety of using high doses of opioids as necessary to relieve suffering. Good symptom control; ongoing involvement with the patient; and physical, psychological, and spiritual support are the hallmarks of quality end-of-life care. Care of patients near the end of life, however, has a moral, psychological, and interpersonal intensity that distinguishes it from most other clinical encounters. With appropriate education, physicians can play a key role to improve care for patients and families who are living with advanced life-threatening illness. Although some issues (e.g., the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, nonmaleficence, beneficence, autonomy, and justice.
The Convention of Human Rights defines violence as "all forms of physical or mental viol... more The Convention of Human Rights defines violence as "all forms of physical or mental violence, injury and abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse". Violence against children cuts across boundaries of geography, race, class, religion and culture. It occurs in homes, schools and streets ; in places of work and entertainment, and in care and detention centers. Perpetrators include parents, family members, teachers, caretakers, law enforcement authorities and other children. Some children are particularly vulnerable because of gender, race, ethnic origin, disability or social status. And no country is immune, whether rich or poor. Although the consequences of violence for children may vary according to its nature and severity, the short- and long-term repercussions are very often grave and damaging. Violence may result in greater susceptibility to lifelong social, emotional, and cognitive impairments and to health-risk behaviors, such as substance abuse and early initiation of sexual behavior. Governments are ultimately responsible for the protection of children. It is therefore up to governments to act now, to fulfill their human rights obligations and other commitments, to ensure the protection of children from all forms of violence. Violence against children is never justifiable. Nor is it inevitable. After providing a global picture of violence against children, we propose recommendations to prevent and respond to this issue.
Les tumeurs de la region pre-sacree sont rares et la plupart sont d'origine congenitale (epid... more Les tumeurs de la region pre-sacree sont rares et la plupart sont d'origine congenitale (epidermoide, teratome, chordome...). Le kyste epidermoide est le plus frequent. Nous presentons le cas d'une femme de 33 ans chez laquelle une masse asymptomatique a ete decouverte dans la region presacree lors de l'accouchement par voie basse et qui s'est revelee etre un kyste epldermoide. Le CT-Scan et l'echo-endoscopie retrouvent une masse kystique bien delimitee dans l'espace presacre. Une discussion des differentes modalites diagnostiques et therapeutiques est faite, et des recommandations generales sont proposees.
We report the case of a 65-year-old woman with an aggressive fibromatosis of the rectus abdominis... more We report the case of a 65-year-old woman with an aggressive fibromatosis of the rectus abdominis muscle suspicious for a metastasis of renal cell carcinoma after tumor nephrectomy 3 years previously. Aggressive fibromatoses (desmoid tumors) are rare semimalignant tumors of the connective tissue with local infiltration and destruction of tissue. Complete resection is essential to avoid tumor relapse. Aggressive fibromatosis must be considered in the differential diagnosis of renal cell carcinoma metastasis. Complete resection and subsequent radiotherapy seem to be the therapy of choice.
Le Journal médical libanais. The Lebanese medical journal
The unprecedented progress in biomedical sciences and technology during the last few decades has ... more The unprecedented progress in biomedical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organization and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront the health professionals more frequently in an increasing range of problems and situations. Health care that has been practiced for centuries on the basis of a direct doctor-patient relationship has been increasingly transformed to a more complex process integrating the health-team, the patient (healthcare seeker) and the community. Systematic review of the specialized literature revealed that Healthcare Ethics Education became a basic requirement for any training program for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for ...
Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer... more Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer cases over the next 20 years, and the biggest rates of increase will occur in the developing world. Owing to technical advances in the care of critical illness, as it is the case in elderly people with advanced cancer, physicians, patients and families are often confronted with ambiguous circumstances in which medical advances may inadvertently prolong suffering and the dying process rather than bring healing and recovery. In this review of the ethical issues confronting physicians who care for patients with advanced life-limiting illnesses like cancer, a philosophical debate continues in the medical community regarding the rightness or wrongness of certain actions (e.g. physician-assisted death, euthanasia), while at the same time there is a strong desire to find a common ground for moral discourse that could guide medical decision-making in this difficult period in the lives of our patients. We will discuss how a good palliative care can be an alternative to these ethical dilemmas. Although some issues (e.g. the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, no malfeasance, beneficence, autonomy and justice. Thus, the physician's primary commitment must always be the patient's welfare and best interests, whether the physician is treating illness or helping patients to cope with illness, disability and death. A key skill here is the communication of bad news and to negotiate a treatment plan that is acceptable to the patient, the family and the healthcare team. Attention to psychosocial issues demands involvement of the patients and their families as partners. Physicians should be sensitive to the range of psychosocial distress and social disruption common to dying patients and their families. Spiritual issues often come to the fore. An interdisciplinary healthcare team can help in these areas. The goals of this review are to raise the awareness of doctors, nurses and other members of the healthcare team to the important ethical issues that must be addressed in providing medical care to elderly patients with advanced cancer; and also to encourage members of the healthcare team to take the ethical issues seriously so that we can improve the circumstances of a vulnerable group of patients-the elderly patients with cancer.
We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid t... more We present a case of breast cancer 9 years after subcutaneous mastectomy for bilateral phylloid tumor with silicone implants. The patient had a stage III adenocarcinoma (T4 N1 M0) at diagnosis; a modified radical mastectomy was done, followed by radiotherapy and chemotherapy. Later on, Tamoxifen was prescribed (positive hormone receptors). Reviewing the literature about this subject in a context of a moratorium of the Food and Drug Administration (FDA) in the United States recommending suspension of silicone breast implantation, we can propose several conclusions: Previous and recent studies did not show any direct relation between cancer and silicone implants for augmentation mammoplasty; on the contrary, a lower incidence of breast cancer is noted. Breast cancer incidence with silicone implants seems to be higher with reconstructive mammoplasty after mastectomy for benign disease (fibrocystic disease, dysplasia, phylloid tumor), or prophylactic reason, or malignancy (carcinoma in situ, lobular and multifocal carcinoma, early breast cancer...). This can be related to recurrence or cancer development on residual breast tissue. Breast cancer with silicone implants is of poorer prognosis because of the later diagnosis of the disease.
L’incidence du cancer et la mortalité par cette maladie sont en nette progression dans le monde, ... more L’incidence du cancer et la mortalité par cette maladie sont en nette progression dans le monde, et plus particulièrement dans les pays en voie de développement, incluant les pays du Moyen-Orient et de l’Afrique du Nord. Les barrières au contrôle du cancer dans ces régions sont d’ordre économique et organisationnel mais aussi dues aux causes culturelles associées à l’ignorance, aux mythes et aux tabous liés au cancer. Il existe plusieurs raisons qui ont stigmatisé le cancer ; la plupart des personnes dans ces régions continuent à considérer que le cancer est une maladie fatale à tous les coups, qu’il peut être contagieux. Il est même parfois considéré comme une punition. Les paroles de patients qui évoquent ces stigmates et ces perceptions sont rapportées. Le rôle de la famille et de la spiritualité est évoqué. Ces mythes et tabous sont un continuel défi pour le contrôle du cancer : ils entraînent un effet contraire aux efforts de sensibilisation et de prévention du cancer. D’où l’objectif n° 5 de la Déclaration universelle de l’UICC de faire disparaître les effets néfastes des mythes et des stigmates. Après avoir passé en revue plusieurs exemples de mythes et de tabous rencontrés dans la pratique, nous rapportons quelques leçons apprises et utiles dans la lutte contre le cancer dans les pays du Moyen- Orient et du nord de l’Afrique.
End-of-life care is an important aspect of medical practice. Individual physicians and the medica... more End-of-life care is an important aspect of medical practice. Individual physicians and the medical community must be committed to the compassionate and competent provision of care to dying patients and their families. Patients rightfully expect their physicians to care for them and provide them with medical assistance as they are dying. To care properly for patients near the end of life, the physician must understand that palliative care entails addressing physical, psychosocial, and spiritual needs and that patients may at times require palliative treatment in an acute care context. To provide palliative care, the physician must be up to date on the proper use of opioids and the legality and propriety of using high doses of opioids as necessary to relieve suffering. Good symptom control; ongoing involvement with the patient; and physical, psychological, and spiritual support are the hallmarks of quality end-of-life care. Care of patients near the end of life, however, has a moral, psychological, and interpersonal intensity that distinguishes it from most other clinical encounters. With appropriate education, physicians can play a key role to improve care for patients and families who are living with advanced life-threatening illness. Although some issues (e.g., the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, nonmaleficence, beneficence, autonomy, and justice.
The Convention of Human Rights defines violence as "all forms of physical or mental viol... more The Convention of Human Rights defines violence as "all forms of physical or mental violence, injury and abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse". Violence against children cuts across boundaries of geography, race, class, religion and culture. It occurs in homes, schools and streets ; in places of work and entertainment, and in care and detention centers. Perpetrators include parents, family members, teachers, caretakers, law enforcement authorities and other children. Some children are particularly vulnerable because of gender, race, ethnic origin, disability or social status. And no country is immune, whether rich or poor. Although the consequences of violence for children may vary according to its nature and severity, the short- and long-term repercussions are very often grave and damaging. Violence may result in greater susceptibility to lifelong social, emotional, and cognitive impairments and to health-risk behaviors, such as substance abuse and early initiation of sexual behavior. Governments are ultimately responsible for the protection of children. It is therefore up to governments to act now, to fulfill their human rights obligations and other commitments, to ensure the protection of children from all forms of violence. Violence against children is never justifiable. Nor is it inevitable. After providing a global picture of violence against children, we propose recommendations to prevent and respond to this issue.
Les tumeurs de la region pre-sacree sont rares et la plupart sont d'origine congenitale (epid... more Les tumeurs de la region pre-sacree sont rares et la plupart sont d'origine congenitale (epidermoide, teratome, chordome...). Le kyste epidermoide est le plus frequent. Nous presentons le cas d'une femme de 33 ans chez laquelle une masse asymptomatique a ete decouverte dans la region presacree lors de l'accouchement par voie basse et qui s'est revelee etre un kyste epldermoide. Le CT-Scan et l'echo-endoscopie retrouvent une masse kystique bien delimitee dans l'espace presacre. Une discussion des differentes modalites diagnostiques et therapeutiques est faite, et des recommandations generales sont proposees.
We report the case of a 65-year-old woman with an aggressive fibromatosis of the rectus abdominis... more We report the case of a 65-year-old woman with an aggressive fibromatosis of the rectus abdominis muscle suspicious for a metastasis of renal cell carcinoma after tumor nephrectomy 3 years previously. Aggressive fibromatoses (desmoid tumors) are rare semimalignant tumors of the connective tissue with local infiltration and destruction of tissue. Complete resection is essential to avoid tumor relapse. Aggressive fibromatosis must be considered in the differential diagnosis of renal cell carcinoma metastasis. Complete resection and subsequent radiotherapy seem to be the therapy of choice.
Le Journal médical libanais. The Lebanese medical journal
The unprecedented progress in biomedical sciences and technology during the last few decades has ... more The unprecedented progress in biomedical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organization and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront the health professionals more frequently in an increasing range of problems and situations. Health care that has been practiced for centuries on the basis of a direct doctor-patient relationship has been increasingly transformed to a more complex process integrating the health-team, the patient (healthcare seeker) and the community. Systematic review of the specialized literature revealed that Healthcare Ethics Education became a basic requirement for any training program for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for ...
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Papers by Michel Daher