Palliative Care Ethics: A Good Companion (Oxford Medical Publications)

Palliative care is a recent branch of health care. The doctors, nurses, and other professionals involved in it took their inspiration from the medieval idea of the hospice, but have now extended their expertise to every area of health care: surgeries, nursing homes, acute wards, and the community. This has happened during a period when patients wish to take more control over their own lives and deaths, resources have become scarce, and technology has created controversial life-prolonging treatments. Palliative care is therefore faced with more ethical problems that other areas of health care. This book, by a clinician, teacher, and writer on health care ethics, has been written to provide all those who care for the terminally ill--doctors, nurses, social workers, clergymen, physiotherapists--with the concepts and principles which will assist them with difficult decisions. It challenges many received doctrines of palliative care, but its well-illustrated central theme is that technical expertise must be controlled by humane, non-technical judgments.

Palliative Care Ethics: A Good Companion

Politics & Social Sciences

Randall, Fiona

Downie, R. S.

Philosophy

Oxford University Press

The expertise of palliative care has recently been extended from the hospice to all areas of medicine. This study examines the ethical problems raised by palliative care. It also challenges some of the accepted doctrines and standard procedures for dealing with the terminally ill.

Palliative care is a rapidly growing area within health care and one in which there are many ethical dilemmas. Chronically and terminally ill patients increasingly wish to take control of their own lives and deaths, resources are scarce and technology has created controversial life-prolonging treatment. This book has been written by a clinician and a teacher and writer of health care ethics to provide all those who care for the terminally ill - doctors, nurses, social workers, physiotherapists, clergy and other careers - with the concepts and principles to assist them in difficult decisions. A central theme, that technical expertise must be controlled by humane, non-technical judgments, runs through the challenging and thoughtful text. Palliative Care Ethics, in this second edition, is now more user- friendly and includes genuine case histories to illustrate ethical issues in the real world. The authors have expanded the section on rationing in response to the changing health care environment and confrontthe issues of patient rights to a far greater extent..There is also a new chapter covering terminally ill children. As the philosophy of palliation is increasingly recognised to be important from diagnosis, the coverage of more general cancer care ethics has been much increased. 'an excellent book' Palliative Medicine 'A thorough reference for practitioners of palliative care' toronto Medical Journal 'The authors tackle many delicate concerns with professional and human integrity' Journal of Medical Ethic

Palliative Care Ethics: A Companion for All Specialties

Health, Fitness & Dieting

Diseases & Physical Ailments

Medical decisions are usually thought to follow from evidence-based science, but this is an oversimplified view. The book investigates the complex nature of evidence in medicine, makes a case for the centrality of clinical judgement, and identifies the elements of good judgement in decisions made in the clinic, in public health, and in resource management. - ;There is a widespread view that modern medicine is primarily a scientific enterprise and that the decisions of clinicians follow from evidence-based science. In terms of this view the need for clinical judgement is minimal. The aims of this book are to make a case for the centrality and irreplaceability of clinical judgement, to identify the elements of good clinical judgement, and to suggest how these might be developed by using the humanities in medical undergraduate and postgraduate education. The authors argue that good clinical judgement requires both technical evidence and a humane attitude. But technical evidence is not always quantifiable or even scientific; it can be like that of the detective or the literary scholar. A humane attitude involves ethical sensitivity, but also a broad educated perspective which can be derived from the arts. The authors illustrate their argument by examining decisions made by doctors in clinical situations, in public health, and (in a chapter contributed by a hospital consultant) in resource management. About the authors: Robert S. Downie is Professor of Moral Philosophy at Glasgow University since 1969. He is a member of the BMA Ethics Committee and co-editor of the Journal of Medical Ethics. He has published extensively in the field of medical ethics. Jane MacNaughton has recently taken the position of Director of Centre for Arts, Humanities, Health and Medicine at the University of Durham. Previously she was Clinical Lecturer in General Practice at Glasgow University and a part-time GP. - ;. . . [A] well-written book . . . lucid discussion of the relation between science and art in clinical medicine . . . I was so impressed with the clarity and intelligence . . . of this book. - The New England Journal of Medicine;This slim well-written book deserves a place on the shelf of anyone who wishes to be a well-rounded, complete physician as well as those training the next generation of doctors. - Karyn Baum, University of Minnesota, USA

Clinical Judgement: Evidence in Practice (Oxford Medical Publications)

Science & Math

MacNaughton, Jane

History & Philosophy

The idea of a philosophy of palliative care emerged with Cicely Saunders' vision for 'a good death' and was developed further with the WHO definition of palliative care. It is now being applied not only to cancer patients, but to all patients in end of life situations. As this 'palliative care approach' advances, it is important to pause and comment on its effectiveness. It is a philosophy of patient care, and is therefore open to critique and evaluation. Using the Oxford Textbook of Palliative Medicine, 3rd edition as their basic reference, Randall and Downie present their argument that the palliative care approach has become too busy and over-professionalised, and that it therefore has significant weaknesses. They examine the framework of the specialty - quality of life, autonomy, dignity, patient-centredness, and the priority assigned to relatives in the remit of care - and the moral problems associated with implementing such a philosophy. The resource implications of various health care policies are also discussed in relation to the WHO definition. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy. Their philosophy prompts many ethical and philosophical questions about the future of palliative care.

The Philosophy of Palliative Care: Critique and Reconstruction

A book for nurses, doctors and all who provide end of life care, this essential volume guides readers through the ethical complexities of such care, including current policy initiatives, and encourages debate and discussion on their controversial aspects. Divided into two parts, it introduces and explains clinical decision-making processes about which there is broad consensus, in line with guidance documents issued by WHO, BMA, GMC, and similar bodies. The changing political and social context where 'patient choice' has become a central idea, and the broadened scope of patients' best interests, have added to the complexity of decision-making in end of life care. The authors discuss issues widely encountered by GPs, nurses, and hospital clinicians. These include patient choice, consent, life prolonging treatment, and symptom relief including sedation. Part two explores the more controversial current end of life care initiatives, such as advance care planning, preferred place of care and death, euthanasia and assisted suicide, extended ideas of 'best interests' and the view that there are therapeutic duties to the relatives of patients. Throughout their discussion the authors draw attention to loose ends and contradictions in some of the proposals. Examining the current policy of consumerist choice, they reject its place in the health service, proposing a realistic, fair, humane, and widely adoptable system of end of life care. As knowledge of ethical theories is required in training courses, and the vocabulary of ethical theory is widespread in current discussions, a substantial appendix on ethical theories and terms is available online. Written by the same authors as The Philosophy of Palliative Care: Critique and Reconstruction, which won the Medical Journalists' Association Specialist Book Award 2007, this new book for non-specialists is essential reading for all health care professionals

End of life choices: Consensus and Controversy

Medical Books

Downie, Robin

Medicine

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