A
Palliative Ethic of
Care: Clinical Wisdom at
Life's End
Joseph J. Fins, MD,
Weill Medical College of
Cornell University/New
York Presbyterian
Hospital-Weill Cornell
Medical Center
Foreword
Preface
Acknowledgements
Permissions
PartI: Death and Dying
in Context
Ch 1: Medical
Students, Residents and
the Dying Patient
The Challenge of Caring
for the Dying
Goal-Setting Near the
End of Life
How this Book is
Organized
Closing Words
Ch 2: The Rise of
the Bioethics and
Palliative Care
Movements
European
Origins of Hospice and
Palliative Care
The
American Context
The Rise
of Self-Determination
Towards an
Ethic of Patients'
Rights
Ch 3: Death, Dying,
and the Law
The Law
and the Rise of
Patient
Self-Determination
Quinlan
and the Right to Die
Quinland
and the
Institutionalization of
Hospital Ethics
Committees
Cruzan
and the Patient
Self-Determination Act
Advance Care Planning in
Theory and Practice
From
Self-Determination to
Physician-Assisted
Suicide
Physician-Assisted
Suicide: Laying Out the
Arguments
Physician-Assisted
Suicide in the Courts
A
Consensus on Palliative
Care
Back
to the Future: The
Schiavo Case
Epilogue
Ch 4: End-of-Life
Care in the Hospital
Death in the
Modern Hospital
Medical Rescue
and Intensive Care
Fostering
Communication
Communication,
Palliation, and the
Road Not Taken
Milestones at the
End-of-Life
Ambivalence and
Medical Futility
Futility: A
Definitional Primer
The Evolution of
Futility Disputes
Goal Convergence,
Palliative Care and
the Avoidance of
Futility Disputes
Part II: Goal-Setting: A
Strategy for Effective
Palliative Care
Ch
5: Goals of Care:
Triggering the Process
Goal-Setting as
Differential
Diagnosis
Triggering the
Process
Concluding Comments
Ch
6: Goals of Care:
When Death is Near
Introduction
Clinical
Perceptions
Patient
Perceptions
When a Patient Wants
to Die
Surrogate
Perceptions
Decision-Making
Capacity
Helping Surrogates
Decide
Ch 7: Goals of Care:
End-of-Life Decisions
Introduction
Do Not Resuscitate
Orders
Advance Care
Planning
Working with the
Proxy
Withdrawals of Care
Hospice or
Palliative Care
Referral
Hospice Care
Ch
8: Goals of Care:
Medical Developments
Introduction
A
Life-Threatening Illness
Prognosis
Acute Decompensation
and the Use of
Life-Sustaining
Therapies
Consideration of ICU
Transfer
Symptoms at the End
of Life
The Ethics of Opioid
Use
Ch
9: Goals of Care:
Gathering Information
Introduction
Sources of
Information
Demographics and Local
Culture
The
Power of Diagnosis
Forced
Prognostication and
Patient Expectations
Assessment of Capacity
and the Refusal of
Life-Sustaining
Therapies
Knowledge
of Diagnosis and
Prognosis
Constructing a Shared
World Meaning with the
Patient and Family
Breaking Bad News
The
Therapeutic Exception
DNR in
the OR
The
Elusive Advance
Directive
Family
Dynamics
The
Symbionic Family
Cultural
Issues: Religious
Objections to Brain
Death
Public
Perspectives on Pain and
Meaning
Biological
Symptom Assessment
Ch
10: Formulating the
Goals of Care
Introduction
Defining Goals
Hospital Resources
Psychiatry
Consultation
Pastoral
Care/Chaplaincy
Pain
Service/Palliative
Care
Consult/Referral to
Palliative Care Unit
Hospice
Referral
Social Work
Ethics Committees
The Centrality of
Communication and
Consensus
Working with Nurses
Involving the
Patient and Family
One Good
Death
Appendix: The Goals of
Care Assessment Tool (GCAT)
Index |
