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Cases illustrating variables that arise in the health care of elderly women and their caregivers, and care of the dying are presented. These include questions about ageism, competence to perform ordinary functions such as driving, possible loss of capacity for moral agency, advance directives, and decisions about forgoing or terminating life-support. For each topic, empirical and theoretical factors are discussed from an “egalitarian perspective” that imputes privileged status to the standpoint of women.

Nearly all ethical issues in teaching can be formulated in terms of what it takes to be a good teacher. This chapter focuses on the ethical issues in death and dying, especially as they overlap with end-of-life issues in medical ethics. What should be the pedagogical aims in teaching these topics to undergraduates? This is an ethical issue addressing the stance of the teacher towards the students and what it means to be a good teacher. The current trend in educational assessment is to focus on the outcomes of education, generally in terms of skills gained. The skills of consulting with others in the emotionally-charged time of facing death and making good decisions are rarely covered. We need to face our limitations in knowing what count as good decisions and well-developed skills. Interdisciplinary courses that focus on difficult decisions are important new developments in education, but they are hard to teach well, challenging conceptions of what a good course is.

This chapter examines the issue of ethical decision making in end-of-life care for children. It explains that decisions at the end of life are fraught with confusion, uncertainty, ambiguity, and deep emotions and that the emotional intensity that surrounds them can magnify the ethical concerns. The chaptersuggests that a moral framework and a commitment to a systematic ethical decision-making process with adequate procedural safeguards are essential for optimal care of dying children.

This chapter introduces the main topic of the book: pediatric end-of-life care. It discusses the concerns with talking to children about dying, before looking at what it is like for the parents and siblings of dying children. Discussing end-of-life options and the role of the medical staff and the pediatric hospice care in pediatric end-of-life care are examined. The last two sections focus on end-of-life care and palliative care.

This chapter provides a detailed review of issues related to end-of-life care. Specific attention is focused on financing the care of dying elders, including information on how care is paid for, the gaps and limitations in coverage, and relevant regulations and policies impacting end-of-life care options. Disparities in care at the end of life are examined. Attention is also focused on cultural factors that influence elders' care decisions. Ethical and legal issues related to end-of-life care for the elderly are addressed, including advanced directives and assisted suicide. The chapter concludes with policy recommendations to improve care at the end of life.

Because we tend to be rather myopic in our discussions of death and dying, especially about the issues of active euthanasia and assisted suicide, it is valuable to place the question of how we go about dying in an international context. This chapter explores the three rather different approaches to end-of-life dilemmas prevalent in the United States, the Netherlands, and Germany — developments mirrored in Australia, Belgium, Switzerland, and elsewhere in the developed world — and consider how a society might think about which model of approach to dying is most appropriate for it. The United States, with the sole exception of Oregon, legally permits only withholding and withdrawal of treatment, “double effect” uses of high doses of opiates, and terminal sedation, all conceived of as “allowing to die”. The Netherlands permits these but also permits voluntary active euthanasia and physician-assisted suicide. Germany rejects physician-performed euthanasia but, at least until recent legal threats, permits assisted suicide not assisted by a physician.

This chapter presents an overview of what we currently know about social inequalities in the experience of dying. A review of existing evidence for social variation in premature mortality, cause, and place of death, is followed by consideration of how access to end of life care services may differ with social position. It concludes with a discussion of how policies and funding can and should influence inequalities in end of life experiences, highlighting areas for future research and advocacy.

This chapter argues that understanding and tackling poverty is an important aspect of end of life care, because it reduces social exclusion and forgone care. The importance of poverty as a source of the inequality and social difference that underlies the social determinants of health inequalities suggests that health care services and policy need a stronger focus on understanding and responding to poverty. Because poverty is multi-dimensional, aligned with other forms of deprivation and inequality, it contributes to the social exclusion of particular groups from participation in society. This arises because people are unable to accumulate social and cultural as well as economic capital in their lives, within families and communities. As a result, interventions on health inequalities must tackle wide aspects of social exclusion, rather than focusing solely on health care services. The chapter also examines the consequences of this analysis of social exclusion for end of life and palliative care. It reviews opportunities for interventions that can contribute to achieving international and national policies on poverty, social difference, and social exclusion, and ensuring that services for dying and bereaved people are not forgone.

This chapter first considers the challenges of end of life care in late old age. It then introduces the concept of ‘frailty’ in older people and the importance of acknowledging dying in old age as a more natural event than dying from cancer or other diseases earlier in the life course. It explores the concept of ‘natural dying’ in the Fourth Age as both an opportunity and a challenge: an opportunity to maximize and learn from the capacity of those living and dying in late old age; a challenge to the current professionalization of death and dying within the developed world, where the focus is on medicalized and ‘abnormal’ death in the very frail older people. Finally, the chapter looks at care homes as a place where older people live and die. It sets out the important role care homes now have in framing end of life care, the demands that beset them, and the aspiration that care homes could be significant in challenging society's taboo of death.

This concluding chapter sums up the key findings of this study on patient choice in end of life care. The philosophy of medicine and of end of life care in particular which emerged in the second half of the 20th century stressed the importance of patient choice in the light of information provided by the doctor. Consumerism is taking over health care, and the best interests of patients are being seen as patients getting whatever it is they choose, in terms of treatments, care and place of death. This chapter suggests that an end of life service should have the following characteristics: realism, fairness, humanity, and adoptability.

This introductory chapter first describes the essential features of palliative care and public health. By indicating how demographic, epidemiological, and societal changes are affecting the circumstances of death and dying and creating societal challenges to its organization, it illustrates how — from a societal perspective — the quality of dying is an issue of health promotion that a society should increasingly consider as a crucial aspect of population health, and provides a sociological justification for adopting a public health approach to end-of-life issues. Next, it elaborates on what this means by describing the concept of the ‘new public health’ and applying it to the end of life. An overview of the subsequent chapters is also presented.

This chapter discusses end-of-life issues as they relate to patients with advanced kidney failure. It focuses mainly on those patients whose kidney failure is being treated by dialysis or by conservative means. The chapter also provides the characteristics of the advanced renal failure population, how to diagnose impending death, and providing care in the last days of a patient's life.

This chapter examines differences that make a difference among people when they negotiate institutions and practices for palliative and end of life care. This has particular resonance given that there is now increasing recognition of how multiple and simultaneous disadvantages can influence palliative care needs and end of life experiences. It offers an understanding of the current controversies with the language of understanding diversity in society. The chapter then explores the experiences of advanced disease among Black and Asian minority ethnic communities and related contributory factors. Finally, it offers a case study of a hospice based in an area characterized by social and cultural diversity, which has attempted to address issues of accessibility and acceptability of its services for the many communities it serves.

This chapter considers the interests of disabled people in the social management of death and dying. It covers: the meaning and nature of disability, including key concepts; the social position and health status of disabled people across the globe; the relevance of disability for end of life care services and practice; and principles for the avoidance of inequity in the provision of support at the end of life.

This chapter examines the scope of palliative nursing care and the responsibilities of the pediatric palliative care (PPC) nurse to children and their families. It explains that PPC nurses facilitate coordination and management of overall palliative care, that they provide end-of-life care for children and therefore require special expertise and personal character to serve their patients with compassion and wisdom. The chapter provides a summary of the pediatric bedside and advance practice palliative care nursing functions.

The dying not only have to take leave from their relatives but also from their own needs, which means taking leave from this world and its pleasures. Understanding dying processes provides answers to the public concerns and discussion about self-determined dying, such as a deep serenity, an inherent dignity, maturation processes, and in general the fact that “more occurs in dying than meets the eye” (comparable to near-death experiences).