A Palliative Ethic Of Care: Clinical Wisdom At Life's End / Edition 1

A Palliative Ethic Of Care: Clinical Wisdom At Life's End / Edition 1

by Joseph J. Fins

binding type PBSee more details below


binding type PB

Product Details

Jones & Bartlett Learning
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Product dimensions:
6.94(w) x 8.44(h) x 0.93(d)

Table of Contents

Part IDeath and Dying in Context1
Chapter 1Medical Students, Residents, and the Dying Patient3
The Challenge of Caring for the Dying3
Goal-Setting Near the End of Life9
How This Book Is Organized10
Closing Words11
Chapter 2The Rise of Bioethics and Palliative Care Movements13
European Origins of Hospice and Palliative Care14
The American Context17
The Rise of Self-Determination19
Toward an Ethic of Patients' Rights22
Chapter 3Death, Dying, and the Law29
The Law and the Rise of Patient Self-Determination29
Quinlan and the Right to Die30
Quinlan and the Institutionalization of Hospital Ethics Committees32
Cruzan and the Patient Self-Determination Act34
Advance Care Planning in Theory and Practice36
From Self-Determination to Physician-Assisted Suicide37
Physician-Assisted Suicide: Laying out the Arguments39
Physician-Assisted Suicide in the Courts41
A Consensus on Palliative Care45
Back to the Future: The Schiavo Case48
Chapter 4End-of-Life Care in the Hospital63
Death in the Modern Hospital63
Medical Rescue and Intensive Care64
Fostering Communication70
Communication, Palliation, and the Road Not Taken72
Milestones at the End of Life73
Ambivalence and Medical Futility77
Futility: A Definitional Primer79
The Evolution of Futility Disputes82
Goal Convergence, Palliative Care, and the Avoidance of Futility Disputes85
Part IIGoal-Setting: A Strategy for Effective Palliative Care91
Chapter 5Goals of Care: Triggering the Process93
Goal-Setting as Differential Diagnosis93
Triggering the Process95
Concluding Comments99
Chapter 6Goals of Care: When Death Is Near101
Clinical Perceptions101
Patient Perceptions104
When a Patient Wants to Die106
Surrogate Perceptions109
Decision-Making Capacity110
Helping Surrogates Decide113
Chapter 7Goals of Care: End-of-Life Decisions119
Do Not Resuscitate Orders121
Advance Care Planning125
Working with the Proxy129
Withdrawals of Care132
Hospice or Palliative Care Referral134
Hospice Care137
Chapter 8Goals of Care: Medical Developments145
A Life-Threatening Illness146
Acute Decompensation and the Use of Life-Sustaining Therapies153
Consideration of ICU Transfer153
Symptoms at the End of Life155
The Ethics of Opioid Use156
Chapter 9Goal-Setting: Gathering Information163
Sources of Information163
Demographics and Local Culture165
The Power of Diagnosis167
Forced Prognostication and Patient Expectations169
Assessment of Capacity and the Refusal of Life-Sustaining Therapies172
Knowledge of Diagnosis and Prognosis174
Constructing a Shared World of Meaning with the Patient and Family176
Breaking Bad News180
The Therapeutic Exception186
DNR in the OR189
The Elusive Advance Directive192
Family Dynamics195
The Symbionic Family198
Cultural Issues: Religious Objections to Brain Death201
Public Perspectives on Pain and Meaning211
Biological Symptom Assessment212
Chapter 10Formulating the Goals of Care225
Defining Goals226
Hospital Resources232
Psychiatry Consultation233
Pastoral Care/Chaplaincy236
Pain Service/Palliative Care Consult/Referral to Palliative Care Unit239
Hospice Referral241
Social Work242
Ethics Committees244
The Centrality of Communication and Consensus250
Working with Nurses252
Involving the Patient and Family255
One Good Death256
AppendixThe Goals of Care Assessment Tool (GCAT)263

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