Caring For Patients At The End Of Life

This book uses easily accessible clinical stories about severely ill patients and their families to illustrate and explore the challenge and potential of end-of-life care, including: 1) the values that underlie medical humanism, 2) communication issues for clinicians, patients and families, and 3) challenging clinical and ethical issues. In "Caring for Patients at the End of Life: Facing an Uncertain Future Together", the author uses his wide range of clinical experience caring for severely ill patients and their families to illustrate the challenges and potential of end-of-life care. Section one utilizes the near death experiences of two patients to explore values underlying medical humanism, and then presents the case of "Diane" to explore the fundamental clinical commitments of partnership and non-abandonment. Section two explores, illustrates, and provides practical guidance for clinicians, patients, and families about critical communication issues including delivering bad news, discussing palliative care, and exploring the wish to die. In section three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In a final chapter, the author discusses the tragic death of his brother which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives.

Palliative care and hospice emerged as a specialty in 2008, with the need to better understand the pathophysiology of chronic suffering, major symptoms at the end of life, and evidence-based management of these symptoms. The common symptoms at the end of life are few, and if appropriately identified and treated, 90 percent or more of patients experience a comfortable, dignified, and peaceful death at their place of preference. Although traditional medical education and training is focused on curing the patient, often we are faced with situations where a cure is not possible and a patient will suffer due to the disease itself or complications of treatment. This book discusses understanding disease patterns, progression, prognostication, preferences, and goals of treatment. Other topics covered include hospice philosophy, Medicare guidelines, and structure of services.