A Palliative Ethic Of Care

"An innovative approach to caring for the terminally ill patient, A palliative ethic of care provides deeper insights into why end-of-life care is so challenging and suggests how to improve the care of the dying" -- Back cover.

A comprehensive analysis of ethical topics in palliative care, combining clinical experience and philosophical rigor. A broad array of topics are explored from historical, legal, clinical, and ethical perspectives, offering both the seasoned clinician and interested lay reader a thorough examination of the complex ethical issues facing patients suffering from life-threatening illness

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers.

The Collaborative for Palliative Care ("Collaborative") is a grassroots consortium of public and private organizations that came together in 2005 for the purposes of studying the increasing need for palliative care and the methods for such care. It has grown from a small fledgling group to a membership of over 50 community-based organizations and volunteers dedicated to improving care of the seriously ill through education, research and advocacy. The Collaborative bridges policy, research and practice in its initiatives and vision for the future. Partners in Palliative Care examines specific areas of concern that the Collaborative has addressed in its education programs and advocacy, as well as the collaborative processes that have been so successful in building community assets. Areas of concentration have been diverse and include advance care planning, relational communication paradigms, community capacity building, the role of culture and spirituality in palliative care, the meaning of pain and suffering for seriously ill individuals, and the ethics of health care costs in palliative and end-of-life systems of care. This book was originally published as a special issue of the Journal of Social Work in End-of-Life and Palliative Care.

Part one of this book provides an explanation of ethical theory, looks at difficult decisions at the end of life, questions autonomy and rights and covers the use of sedation at the end of life, while part two presents case histories and clinical scenarios.

Hospice care is one of the fastest-growing segments of the U. S. healthcare system, a trend that is expected to accelerate as the median age of the population continues to rise over the next three decades. Despite over forty percent of the population now dying while on hospice care, very little has been published on the ethical opportunities and challenges experienced in the everyday lives of those giving and receiving hospice care. This book is the first comprehensive collection devoted to analyzing distinctive ethical issues arising in the delivery of hospice care and designed to promote best ethical practices for hospice care professionals and organizations. Thirteen newly commissioned chapters by seventeen hospice experts populate three thematic sections of the book, each devoted to an aspect of the intersection between ethics and hospice care. Contributors have unique qualifications and abilities to articulate and respond to ethically significant phenomena that -- while not always unique to hospice care -- arise in especially poignant and complex ways when caring for patients enrolled in hospice. As the shift or return to home-based care at the end of life continues, hospice professionals and programs will be faced with a broader array of terminal illnesses, cultural beliefs and traditions, and patient and family values than ever before. Hospice will no longer be tailored solely to the final stage of cancer, but will need to accommodate patients whose illnesses are variable in their progression and whose treatment plans include many medical options. The ethical orientations and frameworks that have served hospice for the past 50 years will need to be supplemented and refined if hospice is to fulfill this changing social mission. Hospice Ethics explores a new paradigm for hospice ethics from a multi-disciplinary and provides an important educational resource for professional training in end of life care.

This book examines the ethics of end of life care, focusing on the kinds of decisions that are commonly made in clinical practice. Specific attention is paid to the intensification of treatment for terminal symptoms, particularly pain relief, and the withdrawal and withholding of care, particularly life-saving or life-prolonging medical care. The book is structured into three sections. The first section contains essays examining end of life care from the perspective of moral theory and theology. The second sets out various conceptual terms and distinctions relevant to decision-making at the end of life. The third section contains chapters that focus on substantive ethical issues. This format not only provides for a comprehensive analysis of the ethical issues that arise in the context of end of life care but allows readers to effectively trace the philosophical, theological and conceptual underpinnings that inform their specific interests. This work will be of interest to scholars working in the area as well as clinicians, specialists and healthcare professionals who encounter these issues in the course of their practice.