Talk:Palliative care

Article Title and proposed merge with Children's hospice

There is a difference between the two specialities of Hospice Care and Palliative Care. I think it's appropriate to have an article about Palliative Care, but Palliative Care is not synonymous with Hospice Care. Hospice Care is not a sub-speciality of Palliative Care which one would almost assume, considering the redirect. The two would certainly share some links, but they are not one in the same. I do get the feeling that some in the newer Palliative Care field would like to blur the distinctions, but there are pro's and con's to each speciality that patients should be aware of. Nightngle 18:01, 27 February 2006 (UTC)

The more I'm thinking about this, I'm wondering if it would be better to title this article "End Of Life Care" and have sections on each specialty and a discussion of how the two are similar and different. Additionally, care in a variety of countries could be discussed as wel, since culture, methods of reimbursement, societal attitudes, etc. all play a part in how end of life care is approached. Nightngle 18:49, 27 February 2006 (UTC)

I think End of Life Care would be a good titles because it is more inclusive of these types of care for the elderly. Either way, this article should NOT be merged with children's palliative care. This is because the type of palliative care provided depends on who receives the care. Let's not generalize topics, but elaborate on them! — Preceding unsigned comment added by 134.121.151.113 (talk • contribs) 10:28, 6 December 2006 (UTC)

I too think that palliative care for children's should have its own article. - Introvert • ~ 02:17, 19 December 2006 (UTC)

I'm saddened that there are views that we should be separating parts of the palliative care community.

1) Palliative v. Hospice: As a palliative care physician who started 25 years ago in the field I can reassure folks that palliative care and hospice care sit together, not seperately. I'm not sure what is meant by the 'newer' field of palliative care means since it first became a speciality (in the UK anyway) nearly 20 years ago in 1989, and was driven by professionals working in many environments, but especially those from hospice. Palliative care is now used as a broad term, recognised by the WHO, to describe any service run by professionals trained in the interdisciplinary care of people with life-threatening and life-limiting illness.
2) Children's v adult palliative care: as a physician working in a hospice with both an adult and a children's unit, I have found it invaluable to have the two services working together, talking to each other and sharing experiences. There are more similarities between us than differences, but we also have much to learn from each other. It is also important to remember that many children with life-threatening and life-limiting illness are now living longer into adulthood. Only by talking together will we be able to help them with these transitions.

A plea- lets keep talking about working together, not about seperating each other! --Claud Regnard 15:21, 29 December 2006 (UTC)

I have found this article because I have had a relative in a hospital under palliative care - and not in a hospice. I knew full well what a hospice was, but not the more euphamistic term "palliative". One can work in palliative care, but not in a hospice, and the term is thus deserving of its own entry. The common misspelling "pallative" (without the 'i') should also be mentioned to aid those searching for information on this topic. Not to be emotional about this, but those who are in need of this information are likely to want as much detailed information about each separate medical term they encounter as possible, rather than read conglomerated articles. 86.137.5.67 01:07, 5 January 2007 (UTC)AC 5 Jan 07

One can receive palliative care without being in a hospice care program (which requires a 6-month prognosis). While the two are interrelated, and should be linked, they are not interchangeable. Jan 22, 2006 — Preceding unsigned comment added by 66.31.79.81 (talk • contribs) 16:56, 22 January 2007 (UTC)

I suspect there is a simple communication issue here. Hospice, in some settings, is a stand-alone service with no links to other services. Some hospital and community services can also be stand-alone. Clearly each provides a different service that is funded and organised very differently.
However, in many settings around the world these services work in an integrated fashion, cross working with the same professionals and in many places organised by a single service. Indeed, some hospital and community services are called 'hospice', while there are hospices who call themselves 'palliative care' units!
There is now an international acceptance of the term 'palliative care' as un umbrella term to describe any services caring for people with progressive life-threatening or life-limiting illness. It has become accepted that this term applies wherever the services are based and however they are organised.
--Claud Regnard 23:37, 4 February 2007 (UTC)

Outdated use of the word HOSPICE

I find the outdated use of Hospice highly offensive. I personallly am living in a nursing home under hospice care. I am NOT expected to die anytime soon, BUT If I were not recieving the top notch around the clock care I am, I would. I am on an active donor list for a new liver, and once I recieve the transplant I am expected to fully recover and return to work. Teamgoon 11:48, 10 May 2007 (UTC)

Alt med

So some areas of alt med like to get involed in palative care. So what? this can be listed on there own pages.Geni 23:10, 8 Jun 2004 (UTC)

My feeling, too. And the Amer. Board of Hospice/Palliative med should not have been dropped. The development of a speciality board for the field is a milestone in the progress that has been seen in the field. Stephen Holland, M.D., Kd4ttc 00:36, 9 Jun 2004 (UTC)

Intro

The introduction needs a lot of work. At the moment it consists of about four very slightly different definitions taken from different sources. It should be rewritten as one single definition, with links to the sources if necessary. -- ALargeElk | Talk 10:27, 9 Jun 2004 (UTC)

And, would you mind writing the correct and complete definition while you are at it? -- [[User:Mr-Natural-Health|John Gohde | Talk]] 10:40, 9 Jun 2004 (UTC)

I've just done it. Since there is a consensus about what PC is I don't see any need to have any references. So I removed them all, combined the definitions and added a little bit on how cure is still considered more important than comfort by many(most) doctors. theresa knott 11:08, 9 Jun 2004 (UTC)

I think there is a need for links to some of the references, as it seems to me there is some argument about what palliative care is. The WHO definition focuses specifically on incurable diseases; the others imply more about using it in addition to curative treatment. Having all four definitions in full doesn't work, purely in terms of readability, but I think it's important to discuss this issue in the intro. I'll have a go when the heat dies down a bit. -- ALargeElk | Talk 11:17, 9 Jun 2004 (UTC)

OK, I've had a go - hopefully still makes sense. -- ALargeElk | Talk 11:46, 9 Jun 2004 (UTC)

That was pretty good, but I just did a somewhat drastic edit which I think is a little more clear & concise. I left in the 1990 definition, but the WHO now also uses the term in the more general sense. I dropped the other 2 references, because they seemed redundant as well as misplaced (they were talking about incurable diseases). I also added a paragraph clarifying why we don't say "palliative" for all incurable diseases; rewrote the last paragraph of the intro slightly to clarify that the concept isn't really new, just newly respected; and added a sentence to lead into the Hospice section. --Hob 05:56, 27 Jul 2004 (UTC)

Also, in the Hospice section: it is (as far as I know) fairly rare to call palliative care in a hospital setting "hospice", so I reworded the first sentence. I struck the last sentence ("The main difference between hospice care and palliative care is that the former is more about nursing while the latter is the physicians' term") because I think it's neither an accurate summary nor really necessary - palliative & hospice were already defined adequately above. --Hob 06:12, 27 Jul 2004 (UTC)

Vickers, 2004 : "Palliative Care and Alternative Medicine"

I am glad to see that Mr-Natural-Health has resumed putting CAM-related content here (when he takes a break from "laughing" at fellow Wikipedians.... sigh ....) Unfortunately, a simple copy-&-paste from "Vickers, 2004" is a copyvio. Please at least take off those numbers and modify the sentences a little. Thanks. -- PFHLai 13:13, 2004 Jun 9 (UTC)

No it's fine to quote as long as it is clearly attributed. ( comes under "fair use") Never the less the numbers should come off as they make no sense here. theresa knott 13:28, 9 Jun 2004 (UTC)

I'd changed this before I read your message, Theresa. Nevertheless, the link to the research had to go, as it specifically states that "Complementary therapies for cancer-related symptoms were not part of this review" - the research is purely into proposed complementary cures. Incidentally, that research makes interesting reading - it debunks the effectiveness of the vast majority of proposed alternative treatments for cancer, and might make an interesting link from another article somewhere. But it's inappropriate for this one.-- ALargeElk | Talk 13:45, 9 Jun 2004 (UTC)

I notice that MNH had made the point earlier that this was in many ways an anti-Alt Med article, and I can understand that it might have been included as an admirable attempt at compromise. But I really can't see that it improves Wikipedia to have a link to research almost entirely unrelated to palliative care in a palliative care article. -- ALargeElk | Talk 14:06, 9 Jun 2004 (UTC)

It doesn't surprise me in the least bit the MNH would quote an article that was not actually saying what he implied it was. I've had a lot of experience with him over the last few months on alternative medicine and iridology and I believe that everything he quotes needs to be thoroughly checked. I didn't check the quote before making my comment though mainly because i wanted to point out that quoting small sectons of works does not make a copyvio. Anyway no harm done as you were clearly on the ball. theresa knott 14:16, 9 Jun 2004 (UTC)

So it's not a copyvio, eh ? Okay, thank you. -- PFHLai 14:32, 2004 Jun 9 (UTC)

You're always fine quoting small sections of articles as long as you put it in quotation marks and say who said it. It's only if you cut and paste then pretend it's your own work, or if you you quote very large chunks or even the whole work that you run into problems. theresa knott 14:54, 9 Jun 2004 (UTC)

If you look at this edit (and especially the edit summary) you'll see that MNH doesn't deny that the bulk of the article is anti-alt med. But it's still not relevant to this article. It's cited as well in Alternative medicine - it might also make sense to cite it in Oncology or something like that.-- ALargeElk | Talk 15:43, 9 Jun 2004 (UTC)

Checking what links to this article [1] shows that alternative medicine related stuff tops the list. Just thought that you might want to know. -- [[User:Mr-Natural-Health|John Gohde | Talk]] 20:36, 16 Jun 2004 (UTC)

The Vickers quote was the wrong citation. That cite showed the ineffectiveness of a number of Alternative Medicine Treatments. The article in the discussion section quoted several studies that supported approaches to palliation that were not discussed in the results section. The correct citations for this article would be the citations referenced by the paper. If the papers are valid it would make a nice addition to this article. Kd4ttc 15:24, 9 Jun 2004 (UTC)

Check out Alternative medicine. All my citations reference the abstract or the full text of the research paper online. The citation that I referenced here provided the full text of the research paper online. I made a direct quote from it. You guys managed to destroy a direct quote. Totally amazing, yet totally predictable. -- [[User:Mr-Natural-Health|John Gohde | Talk]] 02:00, 11 Jun 2004 (UTC)

Treatment of Distress

This section starts with "The key to effective palliative care is to provide a safe place for the individual to express their distress." This sounds like psycho-babble to me. What does this statement mean? 1. What is a "safe place"? - Palliative care is a philosophy that must not be dependant on place. It is rather about the relationship between the patient, their family (however "family" is constructed), the individual clinician and the health care organisation structure. 2. Expression of distress - philosophically "distress" is a construct that does not exist, necessarily, within an individual. Practically, much distress has a physiological aetiology; vomiting, for example. Using vomiting as an exemplar of distress, what does "The key to effective palliative care is to provide a safe place for the individual to express their distress" mean? - Nothing. This initial statement should be removed. Ravenswater 22:18, 11 January 2006 (UTC)

I agree that this section needs some work and perhaps a modification of sub-title. Better might be explaining the role of the interdisciplinary team regarding symptom management. When a patient exhibts a physiological symptom, there is often a psychological, social, and/or spiritual component to that symptom. The chaplain, social worker, and couselors can play a role in helping the patient and family cope with these symptoms, rather than depending on the medical/pharmacologic interventions alone. Perhaps this is what the original author is shooting for. Nightngle 18:10, 27 February 2006 (UTC)

Safe place:
This is an odd phrase isn't it? As the person responsible for putting it in I should explain it in more detail:
It was first coined in 1987 in the journal Palliative Medicine by Averil Stedeford, a psychiatrist with extensive palliative care experience at a hospice in Oxford, UK. She described it as follows:
A safe place to suffer:
'Place' is not a physical environment, but the relationship between a person and their carer.
'Suffer' describes the distress that is left after you have helped any physical, social, or psychiatric problems. It is about the loss that person has, or is going to, experience. Although there are no magic pills or therapies to ease this grief, it is therapeutic for the person to be able to express their distress. However, they will only do so if they are free of troublesome symptoms and, as importantly, they feel it is safe to do so. So this is about trust, good symptom control and listening in a therapeutic relationship.

So not really psycho-babble, but perhaps one of the best definitions of palliative care?
--Claud Regnard 15:35, 29 December 2006 (UTC)

Dead link

During several automated bot runs the following external link was found to be unavailable. Please check if the link is in fact down and fix or remove it in that case!

• http://www.pain.remedica.com
  • In Palliative care on Sun Jul 16 21:24:00 2006, Socket Error: (-2, 'Name or service not known')
  • In Pain on Mon Jul 17 15:19:09 2006, Socket Error: (-2, 'Name or service not known')
  • In Palliative care on Mon Jul 17 17:19:26 2006, Socket Error: (-2, 'Name or service not known')
  • In Pain on Thu Jul 27 00:46:01 2006, Socket Error: (-2, 'Name or service not known')

---

maru (talk) contribs 05:07, 27 July 2006 (UTC)

Thanks again, Maru ~ I am removing this link which I think should've been http://pain.remedica.com; deletion explained at Talk:Pain#dead_link.

Proposing ext links cleanup

In fact, I am inclined to cut the list of links down to just a few (if any), leaving only links to those sites, which clearly provide valuable additional information not yet in the article, as opposed to linking to various "join us" association sites or to professional only, paid subscription magazines. I am concerned that this list is growing out of control and no longer carries any practical value. Any objections, please post away - Introvert • ~ 08:25, 27 July 2006 (UTC)

curative/palliative

First paragraph reads:

providing that the curative therapy will not cause additional morbidity.

Shouldn't this be:

providing that the palliative therapy will not cause additional morbidity.

Seems more logical.

Agreed. -- Steved424 18:36, 9 October 2006 (UTC)

Oh no, but the whole point of that statement in the opening paragraph is exactly that the treatment used must be a delicate one.

I am sure you'd agree if you looked in at the paragraph one more time to see the quoted phrase in its entirety, in the context:

...palliative care ... concentrates on reducing the severity of the symptoms of a disease... rather than provide a cure... it may occasionally be used in conjunction with curative therapy, providing that the curative therapy will not cause additional morbidity.

In other words, the intent of palliative treatment is to support, to relieve a sufferer who may no longer have enough resources for a true curative treatment. Whereas curative therapy can be too aggresive due precisely to its intent to eliminate the disease rather than to just alleviate the symptoms, and extra care should be taken to make sure that the chosen treatment shall not cause more harm than good. - Introvert • ~ 20:23, 10 October 2006 (UTC)

The whole sentence was "However, it may occasionally be used in conjunction with curative therapy, providing that the curative therapy will not cause additional morbidity."

I think that makes sense, and does not need to be changed... It's refering to the cureative treatment, as long as this treatment does not cuase the additional morbidity.

http://www.euthanasiaprocon.org/palliativesub.htm link

I've just done a bit of tidy up on the article, including the external links section. In doing so noticed the above link. It seems to be about a very specific question that this article does not really touch on. And as such I think it's inappropriate for the article. Other opinions? -- Siobhan Hansa 20:02, 8 April 2007 (UTC)

I don't think it is particularly relevant - not to mention the fact that the page itself has minimal content. As such, it doesn't really provide more information. My vote is for removing it. Tamara Young 18:05, 9 April 2007 (UTC)

healthresources advertisements

I deleted many links that were to Health resources journals and papers that were basically just advertisements. This is my first time doing a lot of editing and cleaning up. Is this ok? SpoticusKC 05:00, 19 June 2007 (UTC)

That's been bugging me and it struck me as link spam. The whole article had turned into an advertisement for their content. I just hadn't had the chance to remove them. Thank you. Tamara Young 14:19, 19 June 2007 (UTC)

The IP address 66.252.162.28 has been flagged as a spammer. SpoticusKC 04:10, 28 June 2007 (UTC)

pallimed.org link

I previously removed this link:

Pallimed A hospice & palliative medicine resource, covering palliative care news and research since 2005.

As failing our guidelines on blogs. Another edtor put forth a case that it meets the guideline. I tend to think that an anonymous blog with no official affiliation and with so little traffic it gets no alexa.com ranking is unlikely to be authoritative. However, I wouldn't be able to name the top few palliative care sites so am not the best judge. Do other editors of this page know of this site and consider it authoritative? -- SiobhanHansa 01:26, 29 July 2007 (UTC)

Since the blog is merely aggregating content found elsewhere, it seems that it would be best to simply quote the primary sources rather than link to the blog. It isn't an established authoritative source; it's merely aggregated content. Tamara Young 17:47, 30 July 2007 (UTC)

Correction to SiobhanHansa's statement: "think that an anonymous blog with no official affiliation" The blog is not anonymous as noted in the left hand column.SpoticusKC 01:54, 31 July 2007 (UTC)

Not sure how I missed that. Have struck out the anonymous claim. -- SiobhanHansa 02:10, 4 August 2007 (UTC)

Aggregating content could be argued to a degree on any information source. If the editorial/opinion based commentary that is combined with the links and content does not compromise high value, what would be a better example? If someone could point to an example of a blog that is an authoritative source (allowable by Wikipedia standards) that would be helpful.SpoticusKC 01:54, 31 July 2007 (UTC)

Blogs that are considered appropriate generally are written/sponsored by an individual/institution that is very well known in the field and generally considered by experts to be a voice of authority. It does not have to be "official" but it does need to be generally recognized as an influential site. -- SiobhanHansa 02:10, 4 August 2007 (UTC)

Looking at other permitted links, like Pallcare, (which also does not rank on Alexa), has loads of resources and links and primary information, but I would not necessarily consider it to be authoritative. If we narrow the definition of authoritative to meaning official, the loss of potential resources in general would be large. I would claim Pallimed fits as established (2.5 years of consistent posting), and authoritative as it is written by 2 physicians, and a nurse practioner with appropriate training in the field with a sizeable subscription >300 for a fairly narrow specialty of medicine, with only 2000 or so board certified physicians. And again to be fair, I am one of the co-editors of the blog.SpoticusKC 01:54, 31 July 2007 (UTC)

A site that provides editorial/opinion needs to be written by people (or possibly published by an entity) who are generally recognized as influential in the field (and this is the starting point - it should also be a generally well respected and reliable site). If the experts who edit this page read this blog a lot they should be supporting it - when the only supporters are those with a vested interest in the log's promotion we have to assume that, for now, it does not meet the standard required. We already have a lot of links on this page - we need to be pointing readers to a few of the best, not listing every possible site. -- SiobhanHansa 02:10, 4 August 2007 (UTC)

SH has made some excellent arguments, and I therefore agree. If pallimed does achieve a more official status, it may be reconsidered. Consider the matter complete.SpoticusKC 04:07, 6 August 2007 (UTC)

Why does HOSPICE redirect to PALLIATIVE CARE?

I am shocked to discover that there is no Wikipedia article for "Hospice". Wikidictionary defines "Hospice" as follows

Noun

1. (dated) A lodging for pilgrims or the destitute, normally provided by a monastic order.
2. A facility for the Terminally ill that emphasizes pain control and emotional support for the patient and family, typically refraining from taking extraordinary measures to prolong life.

which is consistent with my understanding. I fully expected Wikipedia to tell me about such places, either in the historic setting or the more modern setting. I certainly did not expect to get automatically redirected to "palliative care", which is a concept and not a place, and not wholly directed to the needs of people at the end of life. The two are connected but they are not synonomous.

I can only presume that there is a reason for this, but right now I cannot see it. Can someone tell me why "Hospice" simply redirects to "Palliative care"?--Tom 14:03, 13 August 2007 (UTC)

I believe it's because we simply haven't had an encyclopedic article written that was substantially different from this one so far. There is some information on hospices in this article, see the history section. Hospice care and palliative care were merged back in 2003, I assume the redirect from hospice was put in place because this article covered the care provided at a hospice and we had no free standing hospice article. If you can write a decent standalone article that is substantially different go right ahead. The redirect stopped readers from being left entirely in the lurch, but providing more appropriate content could serve them better. If writing a standalone article is daunting, it might be easier to enlarge the hospice content in this article first and it can be separated out when it gets large enough. -- SiobhanHansa 16:14, 13 August 2007 (UTC)

I was pretty surprised to see this as well. As a hospice and palliative care MD I am frequently explaining the differences and similarities between the two. If anyone was willing to start a separate hospice article I would be interested in helping, but unfortunately do not have the time to dedicate to initializing the article.

Some of the key points to include

1. That palliative care encompasses hospice as a philosophy of patient centered treatment
2. All hospice is palliative care, but not all palliative care is hospice
3. History of Hospice care in various countries
4. How palliative care as a broader specialty grew out of hospice
5. The medicare hospice benefit
6. Hospice facilities
7. Palliative medicine as an official subspecialty

I think a good starting point to separate these two is to find a couple of key journal articles/references that spell this out well and work from there.SpoticusKC 21:33, 13 August 2007 (UTC)

hospice/pallative care for beginners

I believe this article should be at least two articles, perhaps more to take into account the difference between UK and US versions of hospice/pallative care. As a person completely unfamiliar with either, I found the article to be extremely confusing. I was specifically interested in hospices, but not in pallative care. The article spends A LOT of time comparing and contrasting the two, which many be interesting for someone with a lot of experience in the field, but it is an overabundance of unnecessary and confusing information for a person simply trying to understand the nuts and bolts of a U.S. hospice. And that is the audience I believe Wikipedia seeks to serve.

76.100.197.85 20:33, 3 October 2007 (UTC)

I agree, I only wish I had the time to edit and write the two. SpoticusKC 02:36, 19 October 2007 (UTC)

The confusion is understandable. Palliative care is the speciality that provides multiprofessional care using specially trained carers. Hospice means different things in different countries. In Europe hospice usually means an inpatient facility with day care, outreach and outpatient facilities. In other countries 'hospice' means any palliative care service, usually those going into patient's homes (sometimes called hospice-at-home in the UK). Since all hospice services (community, hospice inpatient, hospital) should be staffed by carers trained in the principles and practice of palliative care, there should be no difference in the type of service provided. --Claud Regnard (talk) 10:46, 6 April 2008 (UTC)

Link suggestion

I would like to submit for the EXTERNAL LINKS section an interview of a palliative care specialist entitled Angels of Mercy. Here's the link: http://www.artsandopinion.com/2004_v3_n1/lewis-palliative.htm Thanking you, Artsandopinion (talk) 20:41, 14 January 2008 (UTC)Robert Lewis

In view of the prominent PayPal request and the many ads on your site's main page, this link would seem to fail WP:EL#Links normally to be avoided, numbers 4, 5 and 6. The fact that your user name is the same as your ezine's suggests you might have a WP:COI, and your talk page is riddled with past spam warnings. If this is a vote to add your link, I vote NO. --CliffC (talk) 01:40, 15 January 2008 (UTC)

I concur that this link should not be included for the above reasons from CLiffC. It also helps that the fact that the interviewer seems to have a utter lack of disrespect for the field by the tone of his initial questions is an additional reason.SpoticusKC (talk) 03:52, 15 January 2008 (UTC)

Thank you for the prompt response. About Spam, I didn't realize until recently that articles had to be submitted first to the TALK page. In respect to PayPal etc, we are a highly respected, legitimate publication. Wiki has already used my articles in its groupie, envy, and Martin Heidegger pages. The interviewing style serves the important purpose of making the piece engaging where the insights offered by the interviewee more than justify your objections. Don't you think? Again thanking you for the consideration. Artsandopinion (talk) 13:45, 15 January 2008 (UTC)Robert Lewis

Proposing a link on talk pages first is what is advised for those with a conflict of interest such as yours, not everyone. I suggest you spend some time reviewing WP:Conflict of interest, as well as WP:External links, especially section WP:External links#How not to be a spammer, since you seem to be a WP:single-purpose account with an agenda only of promoting your web site. -CliffC (talk) 15:20, 15 January 2008 (UTC)

I have looked at the CIO and EL pages. What is as issue here is intentionality; you claim I"m trying to promote Arts & Opinion, when in fact I strongly feel the content of the interview adds significantly to the wiki entry on palliative care. What are your views on the content? Artsandopinion (talk) 16:02, 15 January 2008 (UTC)Robert Lewis

Having read this interview I do not beleive it adds to the Wikipedia entry on palliative care for several reasons:
- although the interviewee seems a caring and dedicated individual the context in which this individual works is unclear. Is this is a well meaning individual acting alone within her team or does she work as an integral part of the wider team?
- the prelude talking of the horrors of dying suggests an unpleasant personal experience colouring this interview (or a vivid imagination). While the end of life is a loss that is hard to bear for all, it is a common experience to be surprised by its gentlensss and the equanimity with which people approach this loss. The key is they do not do so alone and the interviewee is one of many who share this privelge with patients, partners and families.
- the interviewer has not explored the holistic, interdisciplinary nature of palliative care.
- the interview gives the impression that death is the only part of palliative care, ignoring the patients who receive help for months and sometimes years.
-there is no mention or understanding of the specialist role of palliative care. Love alone can results in unecssary physical distress, just as a cold clinical approach can result in unecessary emotional distress.
--Claud Regnard (talk) 22:39, 12 May 2008 (UTC)

I agree with Claude's points.SpoticusKC (talk) 05:04, 14 May 2008 (UTC)