Palliative Medicine and Older People

In this book, the author uses his wide range of clinical experience caring for severely ill patients and their families to illustrate the challenges and potential of end-of-life care. Section One utilizes the near-death experiences of two patients to explore values underlying medical humanism, and then presents the case of “Diane” to explore the fundamental clinical commitments of partnership and non-abandonment. Section Two explores, illustrates, and provides practical guidance for clinicians, patients, and families about critical communication issues including delivering bad news, discussing palliative care, and exploring the wish to die. In Section Three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In the final chapter, the author discusses the tragic death of his brother, which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives. The author exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision making, ensuring medical and palliative care expertise, and committing to see the dying process through to the patient's death, is vividly illustrated.

This book provides a unique view of patients, families, and their caregivers striving together to maintain comfort and hope in the face of incurable illness. The narratives weave together emotions, physical symptoms, spiritual concerns, and the stresses of family life, as well as the professional and personal challenges of providing hospice and palliative care. Based on a vast amount of participant observation and in-depth interviews, the book moves far beyond dry technical manuals for symptom control and tired clichés about death with dignity, to depict the sights, sounds, tastes, and smells of the daily in patients' homes and the palliative care unit. It captures the breathtaking diversity of people's aspirations and ideals as they face death, and the views of the professionals who care for them. Anger and fear, tenderness and reconciliation, jealousy and love, social support and falling through the cracks, unexpected courage and unshakable faith—all of these are part of facing death in late twentieth-century North America, and this book brings them to life in a portrait of the processes of giving and receiving palliative care.

In our society, the overwhelming majority of people die in later life. They typically die slowly of chronic diseases, with multiple co-existing problems over long periods of time. They spend the majority of their final years at home, but many will die in hospitals or care homes. This book explores the possibilities for improving the care of older people dying in residential care and nursing homes. It argues that there are aspects of palliative care that, given the right circumstances, are transferable to dying people in settings that are not domestic or hospice based. The book describes what happens in nursing and residential care homes when a resident is dying, how carers cope, and the practical, health, and emotional challenges that carers face on top of their day-to-day work. Based on research from both the UK and US, the book shows how the situation can be improved.

This is a revised and expanded edition of a classic in palliative medicine, originally published in 1991, with three added chapters and a new preface summarizing our progress in the area of pain management. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly, is suffering? One patient with cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a minor problem—in little pain and not seemingly distressed—said that even coming into the hospital had been a source of pain and suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine? According to the author of this book, these are crucial questions, but ones that have unfortunately remained only queries void of adequate solutions. It is time for the sick person, the author believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, he argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient.

The connection between spirituality and health has received a lot of attention in both the scientific and lay presses. Is religion good for your health? Should doctors talk with their patients about their spiritual or religious beliefs? Should doctors pray with their patients? Through research and evidence, spirituality has been shown to be central to the care of the dying. It is therefore critical that healthcare providers know how to address a patient's spiritual needs. This book presents thinking on how spiritual care can be integrated into traditional caregiving in a practical and informed manner. Chapters that specifically address different religious and cultural perspectives are included. Patients' stories are used throughout to offer real-world experience. With a foreword by the Dalai Lama, the book is a guide for anyone involved in caring for the chronically ill or dying.

This book is a practical and direct handbook for grieving. It presents 30 stories from real life that examine how we grieve and how we can help those who grieve—whether the griever is oneself, someone we care about, or a client or patient. The authors present vignettes from practice that show how death—lingering, unexpected, violent, or self-inflicted—and the loss of a relationship—to oneself or with a child, sibling, parent, mate, grandparent, or friend—give life to grief, together with the process by which each person fully encounters his or her grief. Each story is no more than two or three pages, and the authors follow each one with a short summary of its teachings and a selection of annotated recent references for those who wish to read more about a topic.