Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues.
The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers.
Industry Reviews
"While there is not a standard format imposed on each chapter, the contributors often use clinical cases to illustrate the related ethical challenges. The attention to both breadth and depth of these issues contributes to the book's relevance. ... In addition to practitioners of palliative care, students in health-related fields or those with an interest in bioethics might find this book relevant." --Doody's Health Sciences Book Review
"This outstanding essay collection, edited by Quill and Miller, provides a survey of the clinical and ethical dilemmas clinicians face in palliative care contexts, mainly, but not exclusively, at life's end. The volume helpfully provides perspectives from the diverse disciplines represented in a contemporary palliative care team, general physicians, psychiatrists, nurses, etc. and the diverse locations in which palliative care takes place, from in-home hospice
to inpatient hospital settings. The book treats the major ethical topics that arise in most clinical contexts; this includes issues related to pediatric cases, and also shared decision making and
substituted judgment. [B]ecause of the clinical chapters, the book is best suited for health sciences libraries and professional programs in medicine and nursing. Highly recommended." --A. W. Klink, CHOICE
"This outstanding essay collection, edited by Quill (Univ. of Rochester) and Miller (National Institutes of Health), provides a survey of the clinical and ethical dilemmas clinicians face in palliative care contexts, mainly, but not exclusively, at life's end. The volume helpfully provides perspectives from the diverse disciplines represented in a contemporary palliative care team, general physicians, psychiatrists, nurses, etc. and the diverse locations in
which palliative care takes place, from in-home hospice to inpatient hospital settings." -- Choice
"This is a very good read, not just for professionals working in the fi eld, but for other disciplines,who would like to know more about the origins of palliative care and its relationship to other disciplines." -The Australian Pain Society Newsletter
