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Doody's Review ServiceReviewer: David O. Staats, MD (University of Oklahoma Health Sciences Center)
Description: This second edition monograph sets forth a wide-ranging look at the ethical dimensions encountered in caring for older persons. The first edition had a different title, The Older Person: Consent and Care, English (BMJ Books, 1995).
Purpose: Its purpose is to give life to the "entire culture change" in providing care for older persons in the U.K. based on effective communication, consent, and patient confidentiality that characterize recent reforms in the National Health Service. These are indeed worthy goals and the Committee of the British Medical Association, which authored the monograph (ably edited by Ann Sommerville), has done an excellent job.
Audience: The audience is broad: practitioners caring for older persons, institutions caring for older persons, health planners, and ethicists will derive much from this book. The contributors all have a keen sense of caring for older persons.
Features: The eight chapters begin with an introduction and an excellent chapter on communication followed by chapters on the medical and legal aspects of consent and refusal of treatment. Concluding chapters cover privacy and confidentiality, restraints and commitment, advance directives, and end-of-life care. Each chapter has clinical vignettes and a summary, references, and suggestions for further reading. An appendix of useful organizations concludes the book.
Assessment: This is beautifully written and edited in the precise, elegant, and economical style that characterizes the best of British medical writing. Clear examples help make it easy to understand. That the issues the book deals with concern the clinical care of older persons and not testamentary capacity (to write a will) shows how far thinking in the U.K. has evolved towards more patient-centered care. The U.K. and U.S. concepts on ethical care of older persons are converging and this effective book makes for interesting comparison reading with its American cousins.