Care of the Dying Patient

Care of the Dying Patient

Care of the Dying Patient

Care of the Dying Patient

Synopsis

Although the need for improved care for dying patients is widely recognized and frequently discussed, few books address the needs of the physicians, nurses, social workers, therapists, hospice team members, and pastoral counselors involved in care. Care of the Dying Patient contains material not found in other sources, offering advice and solutions to anyone--professional caregiver or family member--confronted with incurable illness and death. Its authors have lectured and published extensively on care of the dying patient and here review a wide range of topics to show that relief of physical suffering is not the only concern in providing care. This collection encompasses diverse aspects of end-of-life care across multiple disciplines, offering a broad perspective on such central issues as control of pain and other symptoms, spirituality, the needs of caregivers, and special concerns regarding the elderly. In its pages, readers will find out how to effectively utilize palliative-care services and activate timely referral to hospice
-arrange for care that takes into account patients' cultural beliefs
-respond to spiritual and psychological distress, including the loss of hope that often overshadows physical suffering
The authors especially emphasize palliative care and hospice, since some physicians fear that such referrals may be viewed by patients and families as abandonment. They also address ethical and legal risks in pain management and warn that fear of overprescribing pain medication may inadvertently lead to ineffective pain relief and even place the treating team at risk of liability for undertreatment of pain. While physicians have the ability to treat disease, they also help to determine the time and place of death, and they must recognize that end-of-life choices are made more complex than ever before by advances in medicine and at the same time increasingly important. Care of the Dying Patient addresses some of the challenges frequently confronted in terminal care and points the way toward a more compassionate way of death.

Excerpt

For centuries, care of the dying was an occasion for compassion, empathy, ritual, and prayer, not an exercise in ethical decision making. Most cultures possessed customs, symbols, and religious practices designed to provide comfort and solace to dying people and their families. Any decisions made centered on nonmedical issues, such as succession to the dying person’s social role, power, wealth, or possessions. Physicians attended mainly to relieve pain and to make the official pronouncement of death.

All of this has changed drastically in the last half century. Ethical decisions now dominate what formerly was a time of community solicitude. Discord between and among families, physicians, and other health-care professionals is now common. Dissent about divergent potential courses of action in a dying patient’s care constitutes the most frequent reason for ethics consultations. Everyone sincerely wants to do the right and good thing—especially when the patient loses the capacity to voice his or her opinion of what that means. But deciding what is right and good has become vastly more complicated than before due to three overarching changes in our society: the expanded power of medical biotechnology over all phases of human life, the proliferating diversity of cultural and religious belief systems, and the rise of participatory democracy, predominantly, though not exclusively, in Western societies.

Of these three, the precipitating factor is the power of physicians to determine the manner, timing, and quality . . .

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