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Using the Oxford Textbook of Palliative Medicine Third 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.
The contradictions of palliative care literature come under scrutiny as the gulf between the rhetoric and the clinical application of its theory is discussed. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy. In order for palliative care to evolve, it must return to its original simplicity The reconstruction proposed in this text is fascinating reading and prompts many ethical and philosophical questions about the future of palliative care.
About the Author:
Fiona Randall has served on the BMA andAssociation for Palliative Medicine ethics committees
Framework and concepts
1. Root, traditions and philosophy
2. Quality of life
3. Autonomy, dignity, respect and the patient centred approach
Interventions, effectiveness and cost
5. Control of symptoms and prolongation of life
6. Resuscitation and advance statements
7. Assessment and treatment of psychosocial and spiritual problems
8. Resource allocation
Critique and reconstruction: some suggestions for a better way
9. Critique and reconstruction: some suggestions for a better way