End of Life Choices: Consensus and Controversy

ISBN-13: 9780199547333 / Angielski / Miękka / 2009 / 224 str.

Fiona Randall; Robin Downie

Opis

Palliative care is undergoing a period of rapid change, both in perceptible ways such as legislation, policy, and clinical guidelines, but also in its philosophy and ethics. There is ambiguity surrounding even the definitions used, ranging from palliative care, to supportive care, to end of life care. Randall and Downie propose that the uncertainties in the current thinking on end of life care may change the two ethical (and legal) principles on which modern medical care has been built--that practitioners must obtain the informed consent of the patient for treatment, and that practitioners must seek the best health interests of their patients. They examine a wide range of issues, themes, and contradictions prevalent in modern palliative/end of life care. These include: choice, assisted suicide, roles and values, responsibility, rights, Advance Care Plans, withdrawal and withholding of treatment, advocacy, the Mental Capacity Act, best interests, definitions, and the new Department of Health End of Life Care Strategy. Split into two section, End of Life Choices: Consensus and Controversies provides guidance through the ethical minefield that has developed for doctors and nurses who care for patients towards the end of life. The first section discusses some of the issues of end of life care as they are still widely encountered by GPs, nurses, and hospital clinicians. It presents a mainly consensus view on patient choice, consent, life-prolonging treatment, and symptom relief, including sedation. The second section discusses some current controversies, such as advance care planning, preferred place of care and death, physician assisted suicide, and extended ideas of "best interest," including the idea that there are therapeutic duties to the relative of patients. Additional online resources outline the common ethical theories and the vocabulary used in ethical theory which is useful for readers who are taking part in training courses.

Recenzje

A comprehensive exploration of the moral, ethical and medico-legal issues associated with palliative care. It is thought-provoking and provides guidance for many of the problems with which health professionals are faced in their daily work. At £29.95, this is an affordable book which is relevant to anyone caring for patients in the terminal phase of their illness.

O autorze

Having trained in palliative medicine at St Christopher's Hospice, London, under the leadership of Dame Cicely Saunders, Fiona Randall has been a consultant in palliative medicine since 1982. She has a special interest and academic background in health care ethics, and a philosophy PhD. Publications include 'Palliative Care Ethics' and 'The Philosophy of Palliative Care: critique and reconstruction', both Oxford University Press. She has served on the BMA Ethics Committee, and represented the Association for Palliative Medicine in consultations on the Mental Capacity Act and its Code of Practice. She has been involved in producing national guidance on advance care planning, and has given evidence to two House of Lords Select Committees on euthanasia. She serves on her Acute Hospital Clinical Ethics Committee, and teaches nationally and internationally on ethical issues in end of life care. Robin Downie was educated at the Universities of Glasgow and Oxford. Before moving into university teaching he was a Russian interpreter in the Army. He has been a member of Government and professional committees concerned with ethical issues, such as the BMA Ethics Committee and Government Committees on xenotransplantation and genetics. In addition to teaching and writing on topics in moral and political philosophy and the philosophy of science he was involved in teaching ethics to undergraduate and postgraduate medical, dental and nursing students and practitioners. Along with Sir Kenneth Calman (formerly Chief Medical Officer, UK) he began the movement now known as the 'medical humanities' i.e. the use of literature and other arts and humanities in the education of health care professionals. In particular, this way of teaching bioethics takes professionals beyond regulations, widens their perceptions of practice, and affects attitudes to patients.