Ethics in Palliative Care: A Complete Guide

by Robert C. Macauley

Overview

No specialty faces more diverse and challenging ethical dilemmas than palliative medicine. What is the best way to plan ahead for the end of life? How should physicians respond when patients refuse treatments likely to be beneficial, or demand treatments not likely to be? Who makes medical decisions for patients who are too ill to decide for themselves? Do patients have the "right to die" (and, if so, what exactly does that mean)?

In this volume noted palliative care physician and bioethicist Robert C. Macauley addresses a broad range of issues from historical, legal, clinical, and ethical perspectives. Clinically nuanced and philosophically rigorous, Ethics in Palliative Care analyzes hot-button subjects like physician assisted dying and euthanasia, as well as often overlooked topics such as pediatric palliative care, organ donation, palliative care research, and moral distress. Drawing on real cases yet written in non-technical language, this complete guide will appeal to both medical professionals and lay readers.

Product Details

ISBN-13:	9780199313945
Publisher:	Oxford University Press
Publication date:	04/02/2018
Pages:	568
Product dimensions:	9.90(w) x 7.00(h) x 1.40(d)

About the Author

Robert C. Macauley is Cambia Health Foundation Endowed Chair in Pediatric Palliative Care at Oregon Health and Science University. He taught at the University of Vermont College of Medicine for fifteen years, where he directed the Department of Clinical Ethics as well as the Pediatric Advanced Care Team.

Table of Contents

Preface

Section I: Overview and introduction
Chapter 1: Ethics and palliative care
Chapter 2: Overview of ethical approaches

Section II: Ethical issues in determining the plan of care
Chapter 3: Advance care planning and surrogate decision making
Chapter 4: Specific ethical issues at the end of life

Section III: Death and dying
Chapter 5: The "right to die"
Chapter 6: Forgoing life-sustaining medical treatment
Chapter 7: Pain and symptom management at the end of life
Chapter 8: Physician Assisted Dying
Chapter 9: Palliative sedation

Section IV: Pediatric ethics and palliative care
Chapter 10: Overview of pediatric ethics and palliative care
Chapter 11: Ethics of prenatal palliative care
Chapter 12: Ethics of neonatal palliative care
Chapter 13: Ethics of child and adolescent palliative care

Section V: Other topics
Chapter 14: Requests for non-beneficial treatment
Chapter 15: Neuro-palliative care
Chapter 16: Death and organ donation
Chapter 17: Research in palliative care
Chapter 18: Clinical practice of palliative care
Chapter 19: Final thoughts

Frequently used abbreviations
Glossary

Editorial Reviews

Reviewer: Kimbell Kornu, MD, PhD (Saint Louis University)
Description: This is a thorough yet accessible discussion of many ethical issues in palliative care through the lens of four integrated aspects: philosophical ethics, clinical concreteness, historical perspective, and the medicolegal landscape.
Purpose: A book that maintains ethical rigor yet remains accessible to palliative care practitioners is much needed. The author succeeds in meeting these objectives.
Audience: The audience includes all healthcare professionals already at work in the field who seek deeper grounding in the ethical dilemmas specific to palliative care. To this end, the book intentionally minimizes technical language to maximize accessibility. The author is a credible authority on the intersection of ethics and palliative care given his national leadership in both pediatric palliative care and pediatric clinical ethics.
Features: The book covers the entire breadth of ethics issues in palliative care, ranging from the histories and relationship of clinical ethics and palliative care to familiar topics such as advance care planning and physician-assisted dying to less familiar topics such as the ethics of prenatal palliative care. However, a major strength of the book is that it does not sacrifice depth, since the author frames each ethical issue with a concrete case and then systematically provides the historical, clinical, ethical, and medicolegal aspects. Each chapter ends with summary bullet points and an extensive bibliography for further reading. Some chapters feature helpful figures and charts to illustrate distinctions in concepts and explanations of process, such as the ethical permissibility of palliative sedation and how to do an ethics consult. The book contains a helpful apparatus of glossary, index of legal cases, and general index. The book is particularly insightful in balancing in-depth discussion of ethical issues with the nuances of concrete clinical practice. Single authorship on such a diversity of topics is not considered a weakness, but rather is judged a strength due to stylistic unity and explicitly disclosed authorial bias.
Assessment: This book should be required reading for any palliative care professional in particular, and is a useful resource for those learning or teaching clinical ethics in general. While not every reader will agree with the author's conclusions about a particular ethical issue, the book provides excellent analyses of ethical issues in a highly readable, even-handed, and comprehensive fashion, an achievement that cannot be overlooked.

Doody's Review Service

"This book should be required reading for any palliative care professional in particular, and is a useful resource for those learning or teaching clinical ethics in general. While not every reader will agree with the author's conclusions about a particular ethical issue, the book provides excellent analyses of ethical issues in a highly readable, even-handed, and comprehensive fashion, an achievement that cannot be overlooked." — Kimbell Kornu, Doody's

"I [think] this book [is] a remarkable effort and I know it will be a useful reference for anybody who works in palliative care." — Roger Woodruff, International Association for Hospice and Palliative Care Newsletter

"It is rare to find an authoritative, exhaustively researched textbook that is also highly readable. Grounded in historical cases and clinical experience, the book conveys the principles and practice of bioethics with compelling, real-world practicality. Ethics in Palliative Care deserves to become a standard for bioethical studies and clinical training. It is a new classic." — Ira Byock, Founder & Chief Medical Officer, The Institute for Human Caring. Author of Dying Well and The Best Care Possible

"The fields of medical ethics and palliative care have evolved along separate paths, yet in their growth have developed substantial areas of confluence and overlap. In this important new text, Dr. Macauley explains how these two disciplines are woven together, and the important lessons that each can learn from the other. The analysis of some of the topics — including requests for non-beneficial treatment—are among the best I've seen." — Robert D. Truog, Professor and Director, Center for Bioethics, Harvard Medical School

"A brilliant distillation of history, culture, and clinical practice, this volume provides clear and actionable guidance for all clinicians who are caring for the seriously ill. I couldn't put it down. Read this book." — Diane E. Meier, Director, Center to Advance Palliative Care, Mount Sinai School of Medicine

From the Publisher