End of life choices: Consensus and controversy

Paperback | November 15, 2009

byFiona Randall, Robin Downie

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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 oflife 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 thatpractitioners must seek the best health interests of their patients. They will 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, withdrawaland withholding of treatment, advocacy, the Mental Capacity Act, best interests, definitions, and the new Department of Health End of Life Care Strategy.This Palliative care is undergoing a period of rapid change in perceptible ways through legislation, policy, and clinical guidelines, but also in its philosophy and ethics. End of Life Choices: Consensus and Controversies examines a wide range of issues, themes and contradictions prevalent in modernpalliative/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 sections, 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 stillwidely 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 ofcare and death, physician assisted suicide, and extended ideas of 'best interests', including the idea that there are therapeutic duties to the relatives of patients. Additional online resources outline the common ethical theories and the vocabulary used in ethical theory which will be useful forreaders who are taking part in training courses.The authors hope that this book will provide a guide through the complexity of clinical situations and current regulations, and also stimulate informed debate on current controversial issues. It will be of use to all those involved in care of the terminally ill, both specialists and those outsidethe current palliative care domain, as well as policy makers, researchers and ethicists.

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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 oflife care. Randall and Downie propose that th...

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' an...

other books by Fiona Randall

Format:PaperbackDimensions:224 pages, 9.21 × 6.14 × 0.02 inPublished:November 15, 2009Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199547335

ISBN - 13:9780199547333

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Table of Contents

Part 1Introduction1. Patient choice and consent2. Choice and best interests: clinical decision-making in end of life care3. Three logical distinctions in decision-making4. Choice and best interests: life-prolonging treatments5. Choice and best interests: symptom control and the maintenance of function6. Choice and best interests: sedation to relieve otherwise intractable symptoms (terminal sedation)Conclusions to Part 1Part 2 - ControversiesIntroduction7. Choice and advance care planning: definition, professional responsibility8. Preferred place of care and death9. Choice, assisted suicide and euthanasia10. Best interests: extended sensesGeneral conclusions