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In this book, 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 the 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. The author exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision making, ensuring medical and palliative care expertise, and committing to see the dying process through to the patient's death, is vividly illustrated.

Volunteers have a long history of supporting the development and delivery of hospice and palliative care in most countries throughout the world. As hospice and palliative care services anticipate significant increasing and changing demands, it is recognised that volunteers have a vital role to play in supporting the future delivery of services. However, as society changes so too does volunteering. This multi-author text explores the complex phenomenon of hospice and palliative care volunteering from an international perspective and considers the influence on volunteering of different cultures and constructs. The book also explores the likely impact of changes in hospice and palliative care on volunteers and considers how and why volunteering itself is changing and the subsequent implications for managers, organizations, and policy makers. This book does not attempt to offer solutions to the many challenges ahead, but rather poses questions that may help to reflect on new possibilities and opportunities.

This book provides a unique view of patients, families, and their caregivers striving together to maintain comfort and hope in the face of incurable illness. The narratives weave together emotions, physical symptoms, spiritual concerns, and the stresses of family life, as well as the professional and personal challenges of providing hospice and palliative care. Based on a vast amount of participant observation and in-depth interviews, the book moves far beyond dry technical manuals for symptom control and tired clichés about death with dignity, to depict the sights, sounds, tastes, and smells of the daily in patients' homes and the palliative care unit. It captures the breathtaking diversity of people's aspirations and ideals as they face death, and the views of the professionals who care for them. Anger and fear, tenderness and reconciliation, jealousy and love, social support and falling through the cracks, unexpected courage and unshakable faith—all of these are part of facing death in late twentieth-century North America, and this book brings them to life in a portrait of the processes of giving and receiving palliative care.

In our society, the overwhelming majority of people die in later life. They typically die slowly of chronic diseases, with multiple co-existing problems over long periods of time. They spend the majority of their final years at home, but many will die in hospitals or care homes. This book explores the possibilities for improving the care of older people dying in residential care and nursing homes. It argues that there are aspects of palliative care that, given the right circumstances, are transferable to dying people in settings that are not domestic or hospice based. The book describes what happens in nursing and residential care homes when a resident is dying, how carers cope, and the practical, health, and emotional challenges that carers face on top of their day-to-day work. Based on research from both the UK and US, the book shows how the situation can be improved.

Clinical medicine, as a thinking discipline, is concerned with not only what clinicians do but also the reasons they do what they do. When physicians act in medicine they have some purpose or goal in mind. What they actually do and how they go about it is in the service of their purposes and their goals. Such goals are related to the doctor-patient relationship and to the acts of doctoring patients and are involved in being a physician among other physicians working within the institutions of medicine. This book goes deeply into clinical medicine and how clinicians-physicians who care for patients-accomplish these tasks. The central focus of the clinician and of this book is the patient, the sick person. It starts with a story of a woman who may need cardiac surgery. The example reveals the excitement and complexity of real-life medicine, including how much is involved besides the patient and the illness, how many people interact, and the large number of facets that require thought and action. Using many examples from real-life medical practice, each chapter looks at the different kinds of thought involved. From thinking about values to developing wisdom, difficult issues are addressed head on. The care of the dying, predicting what will happen, even what thinking itself is and why one would want to do this exciting and rewarding but difficult work come under discussion in this book.

This is a revised and expanded edition of a classic in palliative medicine, originally published in 1991, with three added chapters and a new preface summarizing our progress in the area of pain management. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly, is suffering? One patient with cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a minor problem—in little pain and not seemingly distressed—said that even coming into the hospital had been a source of pain and suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine? According to the author of this book, these are crucial questions, but ones that have unfortunately remained only queries void of adequate solutions. It is time for the sick person, the author believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, he argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient.

Since the introduction of Medicare and Medicaid in 1965, the American health care system has grown in size and complexity. Muriel R. Gillick takes readers on a narrative tour of American health care, incorporating the stories of older patients as they travel from the doctor’s office to the skilled nursing facility, and examining the influence of forces as diverse as pharmaceutical corporations, device manufacturers, and health insurance companies on their experience. A scholar who has practiced medicine for over thirty years, Gillick offers readers an informed and straightforward view of health care from the ground up, revealing that many crucial medical decisions are based not on what is best for the patient but rather on outside forces, sometimes to the detriment of patient health and quality of life. Gillick suggests a broadly imagined patient-centered reform of the health care system with Medicare as the engine of change, a transformation that would be mediated through accountability, cost-effectiveness, and culture change.

Populations around the world are ageing rapidly; a growing number of people will live to older ages, will experience multiple and complex chronic conditions, and will need some form of care towards the end of their lives. The ageing of society is becoming a major public health issue, posing challenges to social and health care structures in many countries. This book demonstrates the added value of palliative care which, although traditionally focused on cancer and the very end of life, can play a role in strengthening and complementing the care of older people. The book outlines the current state of worldwide policy work, research, and innovations in the field of public health and palliative care for older people and concludes with recommendations for policy and decision makers, at international and national level, to support integrating palliative care widely into health care systems in order to improve access to and quality of palliative care for older people.

Patients with life-limiting illness and their families require the skills of many professionals, but also the support of their community. Psychosocial issues for people with life-limiting and terminal illness are complex and require excellent team work and the ability to look beyond the obvious. Whilst most professionals are comfortable in assessing and supporting even the most intimate of physical problems, assessing and supporting the emotional, social, and spiritual sequelae of terminal illness is challenging. More attention has been given to the psychosocial needs of adults with cancer than for any other group. This new edition of a successful text examines current practice and provision of psychosocial care across the lifespan and includes neonatal palliative care, care of the frail elderly, those with dementia and the marginalized. It is a highly practical text, comprehensively reviewing the current literature and evidence in order to demonstrate good, and better, research-based practice in psychosocial care.

Many hospice social workers must address spiritual issues with their clients, but do not feel competent to do so effectively. This targeted volume draws upon multidisciplinary theory and research to advance a relational model of spiritually sensitive hospice care. The book will help readers elevate their spiritual competence and foster a relationship with their clients that will enrich the experience for all involved. Spirituality and Hospice Social Work helps practitioners understand various forms of spiritual assessment for use with their clients. The book teaches practitioners to recognize a client's spiritual needs and resources, as well as signs of spiritual suffering. It also discusses religious and spiritual practices that clients may use to enhance their spiritual coping. Spirituality and Hospice Social Work stresses the need for interdisciplinary collaboration with other members of the hospice team, along with the value of maintaining professional ethical standards when addressing spiritual issues. Throughout, the importance of spiritual sensitivity and its effect upon client well-being is emphasized.

The connection between spirituality and health has received a lot of attention in both the scientific and lay presses. Is religion good for your health? Should doctors talk with their patients about their spiritual or religious beliefs? Should doctors pray with their patients? Through research and evidence, spirituality has been shown to be central to the care of the dying. It is therefore critical that healthcare providers know how to address a patient's spiritual needs. This book presents thinking on how spiritual care can be integrated into traditional caregiving in a practical and informed manner. Chapters that specifically address different religious and cultural perspectives are included. Patients' stories are used throughout to offer real-world experience. With a foreword by the Dalai Lama, the book is a guide for anyone involved in caring for the chronically ill or dying.

Over a period of almost ten years, the work of the Project on Death in America (PDIA) played a formative role in the advancement of end-of-life care in the United States. The project concerned itself with adults and children, and with interests crossing boundaries between the clinical disciplines, the social sciences, arts, and humanities. PDIA engaged with the problems of resources in poor communities and marginalized groups and settings, and it attempted to foster collaboration across a range of sectors and organizations. This book examines the broad, ambitious conception of PDIA—which sought to “transform the culture of dying in America”—and assesses PDIA's contribution to the development of the palliative care field and to wider debates about end-of-life care within American society. Chapters consider key issues and topics tackled by PDIA grantees which include: explorations of the meanings of death in contemporary American culture; the varying experiences of care at the end of life (in different settings, among different social and ethnic groups); the innovations in service development and clinical practice that have occurred in the US in response to a growing awareness of and debate about end of life issues; the emerging evidence base for palliative and end-of-life care in the US; the maturation of a field of academic and clinical specialization; the policy and legal issues that have shaped development, including the ethical debate about assisted suicide and the Oregon experience; the opportunities and barriers that have been encountered; and the prospects for future development. A final chapter captures developments and milestones in the field since PDIA closed in 2003, and some of the challenges going forward.

This book is a practical and direct handbook for grieving. It presents 30 stories from real life that examine how we grieve and how we can help those who grieve—whether the griever is oneself, someone we care about, or a client or patient. The authors present vignettes from practice that show how death—lingering, unexpected, violent, or self-inflicted—and the loss of a relationship—to oneself or with a child, sibling, parent, mate, grandparent, or friend—give life to grief, together with the process by which each person fully encounters his or her grief. Each story is no more than two or three pages, and the authors follow each one with a short summary of its teachings and a selection of annotated recent references for those who wish to read more about a topic.