Caring for Patients at the End of Life: Facing an Uncertain Future Together / Edition 1

by Timothy E. Quill

Overview

In Caring for Patients at the End of Life: Facing an Uncertain Future Together, Dr. Quill 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 a final chapter, Dr. Quill 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.
Dr. Quill 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 of committing to see the dying process through to the patient's death is vividly illustrated.

Product Details

ISBN-13:	9780195139402
Publisher:	Oxford University Press
Publication date:	03/22/2001
Edition description:	New Edition
Pages:	264
Product dimensions:	9.22(w) x 6.07(h) x 0.71(d)

About the Author

University of Rochester School of Medicine and Dentistry, Rochester, NY

Table of Contents

I. Underlying Values and Assumptions1. Same Old Seventeen Dollar Lamps2. Humanistic End of Life Care3. Death and Dignity: A Case of Individualized Decision Making4. Partnership in the Care of the Dying5. Non-abandonment: A Central Obligation of PhysiciansII. The Medical Interview: A Critical Clinical Tool6. Delivering Bad News7. Discussing Palliative Care with Patients8. Palliative Care for Patients with Severe Dementia: A Consensus-Based Approach to Decision-Making9. Doctor, I want to die! Will you help me?III. Difficult Clinical and Ethical Issues10. Hospice and Palliative Care: Clinical, Ethical and Policy Challenges11. The Rule of Double Effect: A Critique of its Role in End of Life Decision Making12. Palliative Options of Last Resort: A Comparison of Practices, Justifications, and Safeguards13. End of Life Care in the Netherlands and the United States: A Comparison of Values, Justifications, and PracticesEpilogue: All About My Brother

Editorial Reviews

Reviewer: Lisa Stepp, PhD, RN, APN, AOCN, CRNH (Private Practice)
Description: When providing end of life care, healthcare professionals face numerous problems. As an illness progresses, the patient's suffering increases and care of the patient becomes challenging, both clinically and ethically. Healthcare providers need clear direction to be able to provide the best possible palliative care at this crucial time.
Purpose: The purpose of this book, as defined by the author, is to direct the palliative care provider's attention to the values and assumptions underlying terminal care. There seems to remain a great deal of confusion regarding terminal care. These issues clearly need to be discussed openly and honestly and the author provides a forum for this discussion. Although there are numerous publications that address end of life issues, the author uses personal illustrations to provide a framework to guide conversations between physicians and patients.
Audience: The book is designed for clinicians involved in palliative care. Students would also benefit from having this book in their library. The author speaks form personal experience providing end of life care and provides a comprehensive overview of significant dilemmas in this area of healthcare.
Features: The author addresses medical issues as well as how medical decisions are structured in light of legal and ethical considerations. Illustrations of possible discussions between healthcare professionals and patients are presented in a realistic manner.
Assessment: This book provides a window into one individual's journey as a healthcare professional in end of life care.

Doody's Review Service

"Nothing is harder than communication with patients and families at the end of life. Nothing is more important to quality of care than effective communication. Nothing is better for teaching than personal narratives. Nobody puts all this together better than Tim Quill."—Christine K. Cassel, M.D., Professor and Chairman, The Henry L. Schwartz Department of Geriatrics and Adult Development, Mount Sinai School of Medicine

"This book is fresh air for doctors who care for seriously ill patients. Dr. Quill brings the incredible privilege of being a doctor to life on the page. His book transcends the emotional pain and intimacy of accompanying our patients on their path, bringing a concise intellectual clarity and an organized approach to the complicated task of doctoring." — Diane Meier, M.D., Director, Hertzberg Palliative Care Institute and Co-director, Center to Advance Palliative Care, Mount Sinai School of Medicine

"To guide us in end-of-life care, no voice is more respected than Timothy Quill's. In this book, he brings to bear all of his experience, his wisdom and his sensitivity, to help readers through this most difficult of journeys." — Sherwin Nuland, M.D., author of How We Die

"Timothy Quill is a guiding light to the medical profession and to the rest of us who will eventually need help as life comes to its inevitable end. His ability to see how increased longevity has created not just medical dilemmas but complex emotional, spiritual, and familial concerns comes not a moment too soon. This book should be required reading in every medical school and for every doctor nationwide. It should also be a bedside companion for those at the end of life and for those who love them." — Marilyn Webb, author of The Good Death: The New American Search to Reshape the End of Life

From the Publisher

3 Stars from Doody

Caring for Patients at the End of Life provides compelling evidence that Dr Quill's interests and expertise extend beyond this single issue. Rather, he shows that assisting a patient to die when suffering becomes intolerable is only the extreme end of a spectrum of many treatment possibilities.

Most of the chapters are revised versions of coauthored articles published in medical journals. Assembled in this collection, they make a coherent and convenient package of helpful information, which Quill provides with the authority of experience. His case reports and discussions feature both philosophical arguments and practical advice for dealing with the wide variety of end-of-life decisions.
— Journal of American Medical Association

Lawrence J. Schneiderman