100 Questions and Answers about Alchoholism or Palliative Ethics of Care

100 Questions and Answers about Alchoholism

Author: Charles Herrick

This text addresses these problems and answers the most common 100 questions asked by patients and their family about alcoholism/drug abuse and their treatment. Additionally, there are contributions from actual patients throughout.

Interesting book: Tower of Babble or International Politics on the World Stage

Palliative Ethics of Care: Clinical Wisdom at Life's End

Author: Joseph J Fins

Thid book presents a unique, innovative approach to caring for the terminally ill patient. Using vignettes, the text explains how to develop a set of patient/physician goals for improving quality of life, resolving end of life issues, and generally treating dying patients.

Doody Review Services

Reviewer: David B Cotton, MA; MDiv. (Jersey Shore University Medical Center)
Description: Dr. Fins, in a highly readable, conversational style, presents residents and experienced physicians with a two-part guide to the ethics of caring for patients at the end of life. Part one traces the ethical and legal underpinnings of palliative care, along with some historical context for its appearance on the medical-ethical landscape. Part two is a comprehensive guide for practical application, featuring a specific clinical pathway with goal setting as its guiding principle.
Purpose: The purpose is to educate physicians-in-training regarding the best way to care for the dying. It shares principles and offers relevant information on the skills and strategies necessary for developing a plan of care that meets the patient's needs and respects the patient's goals. In the literature and in the life of the hospital, it is evident that physicians are well prepared for high-tech, aggressive, curative interventions. They are, on the other hand, quite ill prepared to address the complex bundle of issues surrounding death and dying. This book takes direct aim at correcting this imbalance.
Audience: The book is directed specifically to physicians-in-training, especially residents and perhaps fellows. Dr.Fins' wealth of experience and impressive educational credentials combine to make this book worthwhile for practitioners at any level. Reading it is like being on rounds with a master!
Features: The book is divided into two distinct sections. The first chapter addresses the audience directly, stating the case for learning what the book teaches. The following three chapters present the historical, ethical, and legal contexts pertinent to the rise of bioethics consults and the growing emphasis on end-of-life care. The second section builds upon this ethical, historical, and legal framework by presenting a practical guide for bedside care of the dying. This section begins by stressing the importance of the often overlooked step of goal-setting. The need to communicate and formulate a plan of care centered on the patient's and/or family's goals is the most important contribution of the book. The entire application section is centered upon the critical issue of the goal of care as the driver of medical decisions. Fins presents the reader with a Goals of Care Assessment Tool (GCAT) in the book's appendix. It is a terrific answer to the medical-ethical dilemma that presents itself when the physician reaches the point of asking the all-too-familiar question, "Which direction should I go from here with this patient?" Exhausted residents may be tempted to skip the first section and cut right to the practical stuff, but those who hang in there will gain a great deal of wisdom in return for a small sacrifice of time.
Assessment: This is a comprehensive, yet concise, compelling review of the concept, the context, and the content of quality end-of-life care. The emphasis on the need for individual medical decisions to be driven and directed by the goal of care is the book's finest hour and most important contribution. Hopefully it will make the pronouncement, "There's nothing more we can do," obsolete. Dr. Fins encourages and empowers the professional with the idea that competent, compassionate, goal-centered care is every bit as rewarding as cure.

Rating

5 Stars! from Doody

Table of Contents:

	Foreword	xi
	Preface	xv
	Acknowledgments	xxv
	Permissions	xxxi
Part I	Death and Dying in Context	1
Chapter 1	Medical Students, Residents, and the Dying Patient	3
	The Challenge of Caring for the Dying	3
	Goal-Setting Near the End of Life	9
	How This Book Is Organized	10
	Closing Words	11
Chapter 2	The Rise of Bioethics and Palliative Care Movements	13
	European Origins of Hospice and Palliative Care	14
	The American Context	17
	The Rise of Self-Determination	19
	Toward an Ethic of Patients' Rights	22
Chapter 3	Death, Dying, and the Law	29
	The Law and the Rise of Patient Self-Determination	29
	Quinlan and the Right to Die	30
	Quinlan and the Institutionalization of Hospital Ethics Committees	32
	Cruzan and the Patient Self-Determination Act	34
	Advance Care Planning in Theory and Practice	36
	From Self-Determination to Physician-Assisted Suicide	37
	Physician-Assisted Suicide: Laying out the Arguments	39
	Physician-Assisted Suicide in the Courts	41
	A Consensus on Palliative Care	45
	Back to the Future: The Schiavo Case	48
	Epilogue	52
Chapter 4	End-of-Life Care in the Hospital	63
	Death in the Modern Hospital	63
	Medical Rescue and Intensive Care	64
	Fostering Communication	70
	Communication, Palliation, and the Road Not Taken	72
	Milestones at the End of Life	73
	Ambivalence and Medical Futility	77
	Futility: A Definitional Primer	79
	The Evolution of Futility Disputes	82
	Goal Convergence, Palliative Care, and the Avoidance of Futility Disputes	85
Part II	Goal-Setting: A Strategy for Effective Palliative Care	91
Chapter 5	Goals of Care: Triggering the Process	93
	Goal-Setting as Differential Diagnosis	93
	Triggering the Process	95
	Concluding Comments	99
Chapter 6	Goals of Care: When Death Is Near	101
	Introduction	101
	Clinical Perceptions	101
	Patient Perceptions	104
	When a Patient Wants to Die	106
	Surrogate Perceptions	109
	Decision-Making Capacity	110
	Helping Surrogates Decide	113
Chapter 7	Goals of Care: End-of-Life Decisions	119
	Introduction	119
	Do Not Resuscitate Orders	121
	Advance Care Planning	125
	Working with the Proxy	129
	Withdrawals of Care	132
	Hospice or Palliative Care Referral	134
	Hospice Care	137
Chapter 8	Goals of Care: Medical Developments	145
	Introduction	145
	A Life-Threatening Illness	146
	Prognosis	149
	Acute Decompensation and the Use of Life-Sustaining Therapies	153
	Consideration of ICU Transfer	153
	Symptoms at the End of Life	155
	The Ethics of Opioid Use	156
Chapter 9	Goal-Setting: Gathering Information	163
	Introduction	163
	Sources of Information	163
	Demographics and Local Culture	165
	The Power of Diagnosis	167
	Forced Prognostication and Patient Expectations	169
	Assessment of Capacity and the Refusal of Life-Sustaining Therapies	172
	Knowledge of Diagnosis and Prognosis	174
	Constructing a Shared World of Meaning with the Patient and Family	176
	Breaking Bad News	180
	The Therapeutic Exception	186
	DNR in the OR	189
	The Elusive Advance Directive	192
	Family Dynamics	195
	The Symbionic Family	198
	Cultural Issues: Religious Objections to Brain Death	201
	Public Perspectives on Pain and Meaning	211
	Biological Symptom Assessment	212
Chapter 10	Formulating the Goals of Care	225
	Introduction	225
	Defining Goals	226
	Hospital Resources	232
	Psychiatry Consultation	233
	Pastoral Care/Chaplaincy	236
	Pain Service/Palliative Care Consult/Referral to Palliative Care Unit	239
	Hospice Referral	241
	Social Work	242
	Ethics Committees	244
	The Centrality of Communication and Consensus	250
	Working with Nurses	252
	Involving the Patient and Family	255
	One Good Death	256
Appendix	The Goals of Care Assessment Tool (GCAT)	263
	Index	267