End Of Life Care And Pragmatic Decision Making

This book provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death.

Developments are taking place in palliative care in which 'patient choice' has become a central idea, and patients have an enlarged idea of their best interests. This book creates debate among all those involved in care of the terminally ill, including specialists, policy makers, researchers and ethicists.

Decision Making near the End of Life provides a comprehensive overview of the recent developments that have impacted decision-making processes within the field of end-of-life care. The most current developments in all aspects of major underlying issues such as public attitudes, the impact of media, bioethics, and legal precedent provide the background information for the text. The authors examine various aspects of end-of-life choices and decision-making, including communication (between and among family, medical personnel, the dying person), advance directives, and the emergence of hospice and palliative care institutions. The book also explores a variety of psychosocial considerations that arise in decision-making, including religion/spirituality, family caregiving, disenfranchised and diverse groups, and the psychological and psychiatric problems that can impact both the dying person and loved ones. Case studies and first-person stories about decision-making, written by professionals in the field, bring a uniquely personal touch to this valuable text.

In Caring for Patients at the End of Life: Facing an Uncertain Future Together, Dr. Quill uses his wide range of clinical experience caring for severely ill patients and their families to illustrate the challenges and potential of end-of-life care. Section one utilizes the near death experiences of two patients to explore values underlying medical humanism, and then presents the case of "Diane" to explore the fundamental clinical commitments of partnership and non-abandonment. Section two explores, illustrates, and provides practical guidance for clinicians, patients, and families about critical communication issues including delivering bad news, discussing palliative care, and exploring the wish to die. In section three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In a final chapter, Dr. Quill discusses the tragic death of his brother which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives. Dr. Quill exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision-making, ensuring medical and palliative care expertise and of committing to see the dying process through to the patient's death is vividly illustrated.

From Ira Byock, prominent palliative care physician and expert in end of life decisions, a lesson in Dying Well. Nobody should have to die in pain. Nobody should have to die alone. This is Ira Byock's dream, and he is dedicating his life to making it come true. Dying Well brings us to the homes and bedsides of families with whom Dr. Byock has worked, telling stories of love and reconciliation in the face of tragedy, pain, medical drama, and conflict. Through the true stories of patients, he shows us that a lot of important emotional work can be accomplished in the final months, weeks, and even days of life. It is a companion for families, showing them how to deal with doctors, how to talk to loved ones—and how to make the end of life as meaningful and enriching as the beginning. Ira Byock is also the author of The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life.

Wish to die statements are becoming a frequent phenomenon in terminally ill patients. Those confronted by these statments need to understand the complexity of such wishes, so they can respond competently and compassionately to the requests. If misunderstood, the statements can be taken at face-value and the practitioner may not recognise that a patient is in fact experiencing ambivalent feelings at the end of life, or they may misinterpret the expressed wish to die as a sign of clinical depression. Public debate about the morality and ethics of various end-of-life care options has exploded in recent years. However, it has never been sensitive to the finer aspects of clinical reality or the experiences of patients. The Patient's Wish to Die: Research, Ethics, and Palliative Care brings together that reality and the patient's voice, combining them with different research approaches. It presents the best available knowledge and research methodologies about patients' wishes at the end-of-life, together with a series of ethical views and a discussion about the clinical implications for palliative care. The book presents material in an open and unbiased manner whilst remaining sensitive to the spiritual and existential dimensions of dying, and to the different cultural views that provide meaning to the individual. Written by the best specialists and ethics scholars from around the world, including palliative care practitioners and end-of-life scholars from countries where assisted dying practices are legalized and from those where it isn't, The The Patient's Wish to Die: Research, Ethics, and Palliative Care will prove essential reading for all those working or studying in the field of palliative care.

Why does a hospital need an ethics consultation? And what about this counselling is ethical? The book explains the background of the development of clinical ethics counselling. It provides new insights into serious decision-making conflicts in everyday clinical life and uncovers the disputes that followed in public. In the search for the ethical understanding of clinical ethics counselling, the book comes across previously unexplored evidence. Step by step, a system is reconstructed that reveals the shape of a significant philosophical school of thought.

Written by experienced authorities from around the world giving a wider international perspective on palliative nursing, this substantially expanded new edition has been specifically adapted to reflect working practices within the NHS. All nurses especially those that are new to palliative care, and those working in other areas of health where palliative skills are required, will find this essential reading.