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Doody's Review ServiceReviewer: David B Cotton, MA; MDiv.(Jersey Shore University Medical Center)
Description: Dr. Fins, in a highly readable, conversational style, presents residents and experienced physicians with a two-part guide to the ethics of caring for patients at the end of life. Part one traces the ethical and legal underpinnings of palliative care, along with some historical context for its appearance on the medical-ethical landscape. Part two is a comprehensive guide for practical application, featuring a specific clinical pathway with goal setting as its guiding principle.
Purpose: The purpose is to educate physicians-in-training regarding the best way to care for the dying. It shares principles and offers relevant information on the skills and strategies necessary for developing a plan of care that meets the patient's needs and respects the patient's goals. In the literature and in the life of the hospital, it is evident that physicians are well prepared for high-tech, aggressive, curative interventions. They are, on the other hand, quite ill prepared to address the complex bundle of issues surrounding death and dying. This book takes direct aim at correcting this imbalance.
Audience: The book is directed specifically to physicians-in-training, especially residents and perhaps fellows. Dr.Fins' wealth of experience and impressive educational credentials combine to make this book worthwhile for practitioners at any level. Reading it is like being on rounds with a master!
Features: The book is divided into two distinct sections. The first chapter addresses the audience directly, stating the case for learning what the book teaches. The following three chapters present the historical, ethical, and legal contexts pertinent to the rise of bioethics consults and the growing emphasis on end-of-life care. The second section builds upon this ethical, historical, and legal framework by presenting a practical guide for bedside care of the dying. This section begins by stressing the importance of the often overlooked step of goal-setting. The need to communicate and formulate a plan of care centered on the patient's and/or family's goals is the most important contribution of the book. The entire application section is centered upon the critical issue of the goal of care as the driver of medical decisions. Fins presents the reader with a Goals of Care Assessment Tool (GCAT) in the book's appendix. It is a terrific answer to the medical-ethical dilemma that presents itself when the physician reaches the point of asking the all-too-familiar question, "Which direction should I go from here with this patient?" Exhausted residents may be tempted to skip the first section and cut right to the practical stuff, but those who hang in there will gain a great deal of wisdom in return for a small sacrifice of time.
Assessment: This is a comprehensive, yet concise, compelling review of the concept, the context, and the content of quality end-of-life care. The emphasis on the need for individual medical decisions to be driven and directed by the goal of care is the book's finest hour and most important contribution. Hopefully it will make the pronouncement, "There's nothing more we can do," obsolete. Dr. Fins encourages and empowers the professional with the idea that competent, compassionate, goal-centered care is every bit as rewarding as cure.