Aging Decisions At The End Of Life

Decisions at the End of Life is the last volume in a trilogy on Aging conceived for the International Library of Ethics, Law, and the New Medicine. Leading scholars from a range of disciplines examine some of the most emotive topics in the study of aging: assessing quality of life, improving end-of-life care, palliative care, euthanasia, and consent to research.

When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."

Ageing populations mean that palliative and end of life care for older people must assume greater priority. Indeed, there is an urgent need to improve the experiences of older people at the end of life, given that they have been identified as the 'disadvantaged dying'. To date, models of care are underpinned by the ideals of specialist palliative care which were developed to meet the needs of predominantly middle-aged and 'young old' people, and evidence suggests these may not be adequate for the older population group. This book identifies ways forward for improving the end of life experiences of older people by taking an interdisciplinary and international approach. Providing a synergy between the currently disparate literature of gerontology and palliative care, a wide range of leading international experts contribute to discussions regarding priority areas in relation to ageing and end of life care. Some authors take a theoretical focus, others a very practical approach rooted in their clinical and research experience. The issues covered are diverse, as are the countries in which discussions are contextualised. Those working in both palliative care and gerontology will find the issues and advice discussed in this book hugely topical and of real practical value.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

Most aged in India are experiencing a highly protracted death in hospitals, entangled in tubes and machines. Such ‘medicalised death’ entails huge psychological, social and financial costs for both patients and their caregivers. There are also many who are dying in abject neglect. However, Government response to end-of-life care has been almost negligible and there is an acute information deficit on dying matters. This book examines different settings where elderly die, including hospitals, family homes and palliative set-ups. The discourse is set in the backdrop of international attempts to restructure and reconfigure the health delivery system for ageing population. It makes critical commentaries on global developments, offers state-of-art reviews of recent advances, substantiates and corroborates facts by personal narratives and case histories. The book overcomes a segmental understanding of the field by weaving various sociological, medical, legal and cultural issues together. Finally, the authors critically examine biomedicine’s potential to meet the complex needs of the dying elderly. In an attempt to bring cultural sensitivity in end-of-life care, they explore the lost Indic ‘art of dying’ which has the potential to de- medicalise death. Increasing public sensitivity to poor dying conditions of the elderly in India and facilitating changes to improve care systems, this book also demonstrates the limitations of the western specialization of death. It will be of interest to academics in the field of Medical Sociology/Anthropology, Medicine, Palliative care, Public Health and Social Work, Social Policy and Asian Studies.

First Published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

Once defiant of death--or even in denial--many American families and health care professionals are embracing the notion that a life consumed by suffering may not be worth living. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and the growing acceptance that less treatment may be better near the end of life.