End of life choices
Consensus and controversy
1. Auflage
Erschienen am 8. Oktober 2009
269 Seiten
978-0-19-157552-5 (ISBN)
Beschreibung
A book for nurses, doctors and all who provide end of life care, this essential volume guides readers through the ethical complexities of such care, including current policy initiatives, and encourages debate and discussion on their controversial aspects. dived into two parts, it introduces and explains clinical decision making-processes about which there is broad consensus, in line with guidance documents issued by WHO, BMA, GMC, and similar bodies. The changingpolitical and social context where 'patient choice' has become a central idea, and the broadened scope of potients' best interests, have added to the complexity of decision-making in end of life care. The authors discuss issues widely encountered by GPs, nurses, and hospital clinicians. These includepatient choice, consent, life-prolonging treatment, and symptom relief including sedation. Part rwo explores the more controversial current end of life care initiatives, such as advance care planning preferred place of care and death, euthanais and assited suicide, extended ideas of 'best interests', and the view that there are therapeutic duties to the relatives of Throughout their discussion the authors draw attention to loose ends and contradictions in some of the proposals. Examining thecurrent policy of comsumerist choice, they reject its place in the health service, proposing a a realistic, fair, humane and widely adoptable system of end of life care. As knowledge of ethical theories is required in training courses, and the vocabulary of ethical theory is widespread in current discussions a substantial appendix on ethical theories and terms is available online. Written by the same authors as The Philosophy of Palliative Care: Critique and Reconstruction, which won the Medical Journalists' Association Specialits Book Award 2007, this new book for non-specialists is essential reading for all health care professionals involved in providing end of life care.
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Inhalt
- Intro
- Contents
- List of abbreviations and acronyms
- Introduction
- Part 1
- 1 Patient choice and consent
- 1.1 Choice: the traditional concept
- 1.2 Consumer choice, the free market and the health service
- 1.3 Some problems with consumerism in end of life care
- 1.4 Implications of a system for end of life care based on consumerism
- 1.5 The roots of the choice agenda
- 1.6 Conclusions
- References
- 2 Choice and best interests: clinical decision-making in end of life care
- 2.1 Understanding the clinical problem
- 2.2 Selecting the treatment options which offer a prospect of net benefit
- 2.3 Assessment of capacity
- 2.4 Making the final decision with patients who have capacity: consent
- 2.5 Making the final decision: patients without capacity
- 2.6 Conclusions
- References
- 3 Three logical distinctions in decision-making
- 3.1 Intended and foreseen consequences: doctrine of double effect
- 3.2 Acts and omissions
- 3.3 Killing and letting die
- 3.4 Conclusions
- References
- 4 Choice and best interests: life-prolonging treatments
- 4.1 Preliminary issues of ethical importance
- 4.2 Understanding the clinical problem
- 4.3 Selecting treatment options that offer a prospect of net benefit
- 4.4 Making the final decision with patients who have capacity
- 4.5 Making the final decision: patients without capacity
- 4.6 Conclusions
- References
- 5 Choice and best interests: symptom control and the maintenance of function
- 5.1 The basis of most moral problems in symptom control
- 5.2 Moral problems of symptom control in patients with capacity
- 5.3 Moral problems of symptom control in patients who lack capacity
- 5.4 Conclusions
- References
- 6 Choice and best interests: sedation to relieve otherwise intractable symptoms (terminal sedation)
- 6.1 Identifying the problems
- 6.2 What makes the analysis difficult
- 6.3 Clinical circumstances where there is consensus
- 6.4 Clinical circumstances which are controversial
- 6.5 Solution to the problems via the doctrine of double effect
- 6.6 Solution via professional guidelines
- 6.7 Anticipating loss of capacity
- 6.8 Conclusions
- References
- Conclusions to Part 1
- Part 2
- Introduction to Part 2: controversies
- 7 Choice and advance care planning (ACP): definition, professional responsibilities
- 7.1 National guidance on ACP
- 7.2 Who should have the discussion with the patient?
- 7.3 When should ACP be instigated?
- 7.4 Information needed by patients for ACP regarding future treatment
- 7.5 Professional responsibility for establishing validity and applicability
- 7.6 Importance of recording and review
- 7.7 Responsibility for taking advance statements into account in best interests judgements
- 7.8 Ethically important common misunderstandings
- 7.9 Support for ACP, advance statements
- 7.10 ACP: an intervention with a limited UK evidence base
- 7.11 Cardiopulmonary resuscitation and ACP
- 7.12 Conclusions
- References
- 8 Preferred place of care and death
- 8.1 The national context
- 8.2 Ethical problems arising from the preferred place of care and death policy
- 8.3 ACP and preferred place of care and death: should we be asking a different question?
- 8.4 Conclusions
- References
- 9 Choice, assisted suicide and euthanasia
- 9.1 The argument from 'moral equivalence'
- 9.2 The argument from the 'right to die'
- 9.3 The argument from dignity
- 9.4 A simple argument and a simple reply
- 9.5 Conclusions
- References
- 10 Best interests: extended senses
- 10.1 'Best interests' extended to 'whole person' or 'holistic' care
- 10.2 Meaning and dignity at the end of life
- 10.3 Best interests and relatives
- 10.4 Conclusions
- References
- General conclusions
- Index
- A
- B
- C
- D
- E
- F
- G
- H
- I
- J
- K
- L
- M
- N
- O
- P
- Q
- R
- S
- T
- U
- V
- W
- Online Appendix to End of Life Care
