Hospice care is one of the fastest-growing segments of the U. S. healthcare system, a trend that is expected to accelerate as the median age of the population continues to rise over the next three decades. Despite over forty percent of the population now dying while on hospice care, very little has been published on the ethical opportunities and challenges experienced in the everyday lives of those giving and receiving hospice care. This book is the first comprehensive collection devoted to analyzing distinctive ethical issues arising in the delivery of hospice care and designed to promote best ethical practices for hospice care professionals and organizations. Thirteen newly commissioned chapters by seventeen hospice experts populate three thematic sections of the book, each devoted to an aspect of the intersection between ethics and hospice care. Contributors have unique qualifications and abilities to articulate and respond to ethically significant phenomena that - while not always unique to hospice care - arise in especially poignant and complex ways when caring for patients enrolled in hospice. As the shift or return to home-based care at the end of life continues, hospice professionals and programs will be faced with a broader array of terminal illnesses, cultural beliefs and traditions, and patient and family values than ever before. Hospice will no longer be tailored solely to the final stage of cancer, but will need to accommodate patients whose illnesses are variable in their progression and whose treatment plans include many medical options. The ethical orientations and frameworks that have served hospice for the past 50 years will need to be supplemented and refined if hospice is to fulfill this changing social mission. Hospice Ethics explores a new paradigm for hospice ethics from a multi-disciplinary and provides an important educational resource for professional training in end of life care.

This book is a thoughtful, informative, and practical guide for anyone involved in caring for the seriously and chronically ill or dying. The connection between spirituality and medicine has been receiving a lot of attention in both the scientific and lay presses recently, but research and
anecdotal evidence all indicate that spirituality is central to the care of the chronically ill and dying. It is therefore critical that healthcare providers who interact with seriously ill patients know how to address their spiritual needs.
This book presents current thinking on how spiritual care can be integrated into traditional caregiving. Part one discusses aspects of spirituality, such as presence, ethics, and relationships. Part two delves into a number of specific religious and theological traditions. Part three offers
practical applications and tools, including storytelling, psychotherapy, dance, music, and the arts. Part four focuses on patients' stories and reflections. The book concludes with appendices that have sample advance directives for Protestant, Catholic, Jewish, and Muslim patients.
Volume editor Christina Puchalski is the director of the George Washington Institute of Spirituality and Health. She is also an associate professor of medicine at the George Washington University Medical Center and an active practicing physician and medical educator. Dr. Puchalski is nationally and
internationally recognized as a pioneer in the integration of spirituality and healthcare. Chapters are authored by an impressive group of medical and religious experts, and patients' stories also appear throughout, offering real-world examples. The book features a foreword by theDalai
Lama.

Decisions about life-sustaining treatment are often ethically challenging for patients, surrogate decision-makers, and health care professionals. Providing safe, effective, and compassionate care near the end of life is a priority for health care organizations. In times of uncertainty, crisis, or reflection, and in efforts to improve health care for seriously ill patients, guidelines can help. This is the first updated, expanded edition of The Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying, which shaped the ethical and legal framework for decision-making on treatment and end-of-life care in the United States. The new edition, the product of an authoritative consensus process, incorporates 25 years of research, innovation, and developments in law and policy. It summarizes the current framework for making good decisions about treatment and care and identifies educational and organizational goals for health care systems. It covers care planning, decision-making for adults and for children, care transitions, the determination of death, and the policies and processes that support good care at the bedside. It also addresses the psychological and social dimensions of care near the end of life, with attention to effective communication with patients and loved ones and among team members. This book is written for physicians, nurses, and other clinicians in hospitals, nursing homes, home care, and hospice. It is structured for ease of reference during difficult clinical situations and includes extensive practical recommendations supported by print and online resources. This book is also essential reading for clinical ethicists, ethics committee members, health lawyers, and medical and nursing directors. As the U.S. confronts the challenges of health care reform, an aging population, increasing technological capacity to extend life, and serious cost implications, The Hastings Center Guidelines are invaluable to educators, scholars, and policymakers.

Heart failure occurs in almost epidemic proportions, placing a huge burden on both the healthcare system, and sufferers and their families. This can only rise over coming years as the ageing population, particularly in industrialized countries, increasingly suffers from heart failure and its related comorbidities. The care of this group of patients has evolved significantly over recent years as our knowledge and understanding of the pathophysiology of heart failure has developed. It has become evident that supportive care is integral to comprehensive heart failure care, and this book provides an evidence-based overview of heart failure aetiology, its management, and the supportive care required by patients throughout the course of their disease. Supportive Care in Heart Failure integrates the complexities of heart failure care, bridging knowledge bases from cardiology and cardiothoracic surgery, general medicine and palliative care. The book reviews essential information about epidemiology and pathophysiology of heart failure, and evidence-based medical, device, surgical and interdisciplinary management. It addresses the evaluation and management of quality of life, common symptoms and problems associated with heart failure, and the holistic approach to supportive care throughout the course of the illness through the end of life. Prognostication, communication, and ethical decision making are reviewed in detail. Heart failure has traditionally presented a challenge to physicians, as a generally progressive condition with significant symptoms, a poor quality of life, and high mortality. But by applying the principles of palliative medicine, it is possible to offer a supportive care approach that synthesizes the experience of both the heart failure specialist and the palliative care physician, and offers the best possible quality of care to this group of patients.

In Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life, Miller and Truog challenge fundamental doctrines of established medical ethics. They argue that the routine practice of stopping life support technology in hospitals causes the death of patients and that donors of vital organs (hearts, lungs, liver, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. These practices are ethically legitimate but are not compatible with traditional rules of medical ethics that doctors must not intentionally cause the death of their patients and that vital organs can be obtained for transplantation only from dead donors.
In this book Miller and Truog undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. They expose the misconception that stopping life support merely allows patients to die from their medical conditions, and they dispute the accuracy of determining death of hospitalized patients on the basis of a diagnosis of "brain death" prior to vital organ donation. After detailing the factual and conceptual errors surrounding current practices of determining death for the purpose of organ donation, the authors develop a novel ethical account of procuring vital organs. In the context of reasonable plans to withdraw life support, still-living patients are not harmed or wronged by organ donation prior to their death, provided that valid consent has been obtained for stopping treatment and for organ donation.
Recognizing practical difficulties in facing the truth regarding organ donation, the authors also develop a pragmatic alternative account based on the concept of transparent legal fictions. In sum, Miller and Truog argue that in order to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics.

New York Times Bestseller A poignant love letter to Bloom's husband and a passionate outpouring of grief, In Love reaffirms the power and value of human relationships. In January 2020, Amy Bloom travelled with her husband Brian to Switzerland, where he was helped by Dignitas to end his life while Amy sat with him and held his hand. Brian was terminally ill and for the last year of his life Amy had struggled to find a way to support his wish to take control of his death, to not submerge 'into the darkness of an expiring existence'. Written with piercing insight and wit, In Love is Bloom's intimate, authentic and startling account of losing Brian, first slowly to the disease of Alzheimer's, and then on becoming a widow. It charts the anxiety and pain of the process that led them to Dignitas, while never avoiding the complex ethical problems that are raised by assisted death. 'Poignant, kind, funny and ultimately redemptive' - Alain de Botton, author of The Course of Love 'In Love is a thrillingly beautiful, laser-eyed book about love, life, mortality and, most remarkably, about the ways in which no one of the three can be separated from the others' - Michael Cunningham, author of The Hours and A Home at the End of the World

Handbook of Supportive and Palliative Radiation Oncology serves as a practical tool and rapid reference to assist radiation oncology practitioners in direct patient care with common palliative care issues. Containing the most recent advances in translational palliative care research, each chapter is organized in a succinct fashion to discuss major symptom burdens, suggested assessment, and various management options. Each symptom and disease section is written to be a rapid, practical guide for clinicians on the floor. The book starts with general approaches in palliative radiation oncology that are followed by a section that focuses on common symptoms in palliative care and their management. The next section of the book is devoted to site and disease-specific evaluation, intervention, and management. This handbook provides general guidelines and management recommendations for common clinical vignettes encountered by palliative radiation oncology practitioners and supported by palliative radiation oncology research. Concise references are cited to support treatment recommendation.

Hospital intensive care units have changed when and how we die-and not always for the better. The ICU is a new world, one in which once-fatal diseases can be cured and medical treatments greatly enhance our chances of full recovery. But, paradoxically, these places of physical healing can exact a terrible toll, and by focusing on technology rather than humanity, they too often rob the dying of their dignity. By some accounts, the expensive medical treatments provided in ICUs also threaten to bankrupt the nation. In an attempt to give patients a voice in the ICU when they might not otherwise have one, the living will was introduced in 1969, in response to several notorious cases. These documents were meant to keep physicians from ignoring patients' and families' wishes in stressful situations. Unfortunately, despite their aspirations, living wills contain static statements about hypothetical preferences that rarely apply in practice. And they created a process that isn't faithful to who we are as human beings. Further confusing difficult and painful situations, living wills leave patients with the impression that actual communication with their physicians has taken place, when in fact their deepest desires and values remain unaddressed. In this provocative and empathetic book, medical researcher and ICU physician Samuel Morris Brown uses stories from his clinical practice to outline a new way of thinking about life-threatening illness. Brown's approach acknowledges the conflicting emotions we have when talking about the possibility of death and proposes strategies by which patients, their families, and medical practitioners can better address human needs before, during, and after serious illness. Arguing that any solution to the problems of the inhumanity of intensive care must take advantage of new research on the ways human beings process information and make choices, Brown imagines a truly humane ICU. His manifesto for reform advocates wholeness and healing for people facing life-threatening illness.

A practical guide for understanding how palliative care can improve quality of life for patients and their caregivers. Robin Bennett Kanarek was a registered nurse working with patients suffering from chronic medical conditions when her ten-year-old son was diagnosed with leukemia. As her son endured grueling treatments, Robin realized how often medical professionals overlook critical psychological, emotional, and spiritual support for people with life-threatening illnesses. Living Well with a Serious Illness is the culmination of decades of Robin's work to advance the field of palliative care. Although palliative care is often associated with hospice and end-of-life planning, Kanarek argues for a more expanded definition that incorporates palliative care earlier in patients' journeys. Living Well with a Serious Illness helps patients and their caregivers understand • what palliative care entails • how to access the support they need when going through a serious illness • what questions to ask medical professionals • how to navigate advanced care planning • definitions of common terminology used with end-of-life planning • the importance of spiritual care, coping strategies, and emotional support • how to become an advocate for palliative care This book illuminates the importance of seeing patients as individuals who can benefit from care for their body, mind, and spirit—the core tenet of palliative care.

On a blustery night, detectives from the Massachusetts State Police knocked on Amy Gleason's door. Gleason, along with fellow nurse Kim Hoy, had helped a patient deal with pain and suffering at the end of her life. Now the patient was dead, and the two nurses were being investigated for murder. Both believed they had done the right thing, but they had no idea what it would cost them. In this captivating and powerful true story, Dr. Lewis M. Cohen uses the experiences of Gleason, Hoy, and the nursing assistant who accused them of murder to explore what happens when decisions about end-of-life care shift from the hospital to the courtroom and the church. Tracing this issue from the uproar over Terri Schiavo's feeding tube to the controversial figure of Jack Kevorkian, and to the legitimate threat of serial killer medical professionals, Cohen goes behind the scenes on both sides of this debate. He examines how advances in modern medicine have given us tremendous tools for prolonging life but have also forced us to address how we treat patients who are dying and suffering.

Palliative and End-of-Life Care, 2nd Edition provides clinicians with the guidelines and tools necessary to provide quality, evidenced-based care to patients with life-limiting illness. This text describes the care and management of patients with advanced disease throughout the disease trajectory, extending from diagnosis of advanced disease until death. Four units provide the general principles of palliative and end-of-life care, important concepts, advanced disease management, and clinical practice guidelines. Clinical practice guidelines offer in-depth discussions of the pathophysiology of 19 different symptoms, interventions for specific symptom management (including in-depth rationales), and suggestions for patient and family teaching. Defines dying as a normal, healthy process aided by the support of an interdisciplinary team. Provides in-depth pathophysiology, assessment, and intervention information based upon the disease trajectory. Highlights opportunities for patient and family teaching. Describes psychosocial issues experienced by patients and their families. Reviews uncomplicated and complicated grief and mourning, providing suggestions to help the family after a patient's death. Includes case studies at the end of chapters to reinforce key concepts of compassionate care. New chapters including Advance Care Planning, Ethical Issues, Spiritual Care Across Cultures, Pharmacology, Sleep, and Nutrition. Includes a new appendix on Assessment Tools and Resources for more comprehensive coverage of palliative and end-of-life care.

The first book of its kind, this must-have resource examines the integration of palliative interventions from a disease-specific approach, providing practical guidance on caring for patients who follow a progressive, chronic disease trajectory prior to death. This uniquely practical book addresses all aspects of palliative care, going beyond theoretical information to advise practitioners on the most effective management of common symptoms and providing physical, psychological, and spiritual comfort to patients and families. The multidisciplinary focus of care is reflected by collaborative contributors and diverse authorship of an oncology/palliative care nurse practitioner, a physician, and a social worker. Expert authors in the field of palliative care - an oncology/palliative care nurse practitioner, an MD, and a social worker - represent the collaborative nature of caring for chronically ill patients. The most common illnesses that cause death in the United States are addressed in separate chapters on specific disease states: Cardiovascular, Pulmonary, Nephrology, Oncology, and Neurology. Case studies at the conclusion of each chapter illustrate important patient scenarios in the context of clinical practice. Comprehensive drug information for symptom management and comfort measures is provided in an appendix, as well as palliative care assessment tools and helpful website resources. An entire chapter is devoted to cancer pain. Objectives at the beginning of each chapter introduce the reader to concepts that will be addressed in that chapter. Each chapter ends with multiple-choice objective questions to test the reader's comprehension, with answers and rationales provided in the back of book. Prognostic tables demonstrate precisely how and when to integrate palliative interventions into the course of an advanced illness, identifying prognostic indicators where appropriate. Other important topics are covered with chapters on sleep, ethics, cultural and spiritual issues, and the dying process.

Over a period of almost 10 years, the work of the Project on Death in America (PDIA) played a formative role in the advancement of end of life care in the United States. The project concerned itself with adults and children, and with interests crossing boundaries between the clinical disciplines, the social sciences, arts and humanities. PDIA engaged with the problems of resources in poor communities and marginalized groups and settings, and it attempted to foster collaboration across a range of sectors and organizations. Authored by medical sociologist David Clark, whose research career has focused on mapping, archiving and analyzing the history and development of hospice, palliative care and related end of life issues, this book examines the broad, ambitious conception of PDIA - which sought to 'transform the culture of dying in America' - and assesses PDIA's contribution to the development of the palliative care field and to wider debates about end of life care within American society. Chapters consider key issues and topics tackled by PDIA grantees which include: explorations of the meanings of death in contemporary American culture; the varying experiences of care at the end of life (in different settings, among different social and ethnic groups); the innovations in service development and clinical practice that have occurred in the US in response to a growing awareness of and debate about end of life issues; the emerging evidence base for palliative and end of life care in the US; the maturation of a field of academic and clinical specialization; the policy and legal issues that have shaped development, including the ethical debate about assisted suicide and the Oregon experience; the opportunities and barriers that have been encountered; and the prospects for future development. A final chapter captures developments and milestones in the field since PDIA closed in 2003, and some of the challenges going forward.

This comprehensive revision of the invaluable reference presents a rigorous survey of pain and palliative care phenomena across the lifespan and across disciplines. Grounded in the biopsychosocial viewpoint of its predecessor, it offers up-to-date understanding of assessments and interventions for pain, the communication of pain, common pain conditions and their mechanisms, and research and policy issues. In keeping with the current public attention to painkiller use and misuse, contributors discuss a full range of pharmacological and non-pharmacological approaches to pain relief and management. And palliative care is given expanded coverage, with chapters on interventive, ethical, and spiritual concerns. * Pain, intercultural communication, and narrative medicine. * Assessment of pain: tools, challenges, and special populations. * Persistent pain in the older adult: practical considerations for evaluation and management. * Acute to chronic pain: transition in the post-surgical patient. * Evidence-based pharmacotherapy of chronic pain. * Complementary and integrative health in chronic pain and palliative care. * The patient's perspective of chronic pain.* Disparities in pain and pain care. This mix of evolving and emerging topics makes the Second Edition of the Handbook of Pain and Palliative Care a necessity for health practitioners specializing in pain management or palliative care, clinical and health psychologists, public health professionals, and clinicians and administrators in long-term care and hospice.

The Guest Editors have secured top experts in the area of palliative care to write current and clinically relevant articles. Articles in this issue are devoted to: Caring for LGBT Populations; Integrating Palliative Care into Primary Care; Pain Management in the Cognitively Impaired; Pain Management in the Client with Substance Use Disorder; Rituals at End of Life; Death Bed Phenomena; Family Care During End of Life; Palliative Wound Care; Pet-Assisted Therapy in Palliative Care; Palliative Sedation: State of the Science. Readers will come away with the updated information they need to provide state-of-the-art palliative care to their patients.

aThis is a beautifully written account from the front lines of a struggle between a federal drug war complex determined to keep demonizing marijuana and the growing movement of patients and doctors who have found marijuana to be a valuable medicine. Voters in California and many other states have strongly supported the patients. The moving stories in this book show why.a
--Craig Reinarman, co-author of "Crack in America: Demon Drugs and Social Justice"

aChapkis and Webb have done a masterful job in describing the intricacies of the drug debate and offer brilliant analysis on a complex and controversial subject. Both baby boomers and the current teenage population will find this book important and compelling reading.a
--Terry Williams, author of "Crackhouse: Notes from the End of the Line"

Marijuana as medicine has been a politically charged topic in this country for more than three decades. Despite overwhelming public support and growing scientific evidence of its therapeutic effects (relief of the nausea caused by chemotherapy for cancer and AIDS, control over seizures or spasticity caused by epilepsy or MS, and relief from chronic and acute pain, to name a few), the drug remains illegal under federal law.

In Dying to Get High, noted sociologists Wendy Chapkis and Richard J. Webb investigate one community of seriously-ill patients fighting the federal government for the right to use physician-recommended marijuana. Based in Santa Cruz, California, the Wo/Menas Alliance for Medical Marijuana (WAMM) is a unique patient-caregiver cooperative providing marijuana free of charge to mostly terminally ill members. For a brief period in 2004, it even operated the only legalnon-governmental medical marijuana garden in the country, protected by the federal courts against the DEA.

Using as their stage this fascinating profile of one remarkable organization, Chapkis and Webb tackle the broader, complex history of medical marijuana in America. Through compelling interviews with patients, public officials, law enforcement officers and physicians, Chapkis and Webb ask what distinguishes a legitimate patient from an illegitimate apothead, a agooda drugs from abad, a medicinal effects from ajust getting high.a Dying to Get High combines abstract argument and the messier terrain of how people actually live, suffer and die, and offers a moving account of what is at stake in ongoing debates over the legalization of medical marijuana.

Handbook of Pain and Palliative Care:Biobehavioral Approaches for the Life Course Rhonda J. Moore, editor This book takes both a biobehavioral and a lifespan approach to understanding long-term and chronic pain, and intervening to optimize patients' functioning. Rich in clinical diversity, chapters explore emerging areas of interest (computer-based interventions, fibromyalgia, stress), ongoing concerns (cancer pain, low back pain), and special populations (pediatric, elderly, military). This coverage provides readers with a knowledge base in assessment, treatment, and management that is up to date, practice strengthening, and forward looking. Subject areas featured in the Handbook include: Patient-practitioner communication Assessment tools and strategies Common pain conditions across the lifespan Biobehavioral mechanisms of chronic pain Pharmaceutical, neurological, and rehabilitative interventions Psychosocial, complementary/alternative, narrative, and spiritual approaches Ethical issue and future directions With the rise of integrative perspective and the emphasis on overall quality of life rather than discrete symptoms, pain management is gaining importance across medical disciplines. Handbook of Pain and Palliative Care stands out as a one-stop reference for a range of professionals, including health practitioners specializing in pain management or palliative care, clinical and health psychologists, public health professionals, and clinicians and administrators in long-term care and hospice.

This issue of Clinics in Geriatric Medicine is devoted to Palliative Care. Guest Editors Thomas Smith, MD and Madeline Leong, MD have assembled a group of expert authors to review the following topics: Palliative Care in the Era of Healthcare Redesign; Communications to Patients; Communications by Professionals; International Palliative Care; Public Health and Palliative Care; Culturally Relevant Palliative Care; Spirituality, Religion, and Healing in Palliative Care; Alternative, Complementary and Mainstream Therapies in Palliative Care; Symptom Management in the Older Adult; Interaction of Palliative Care and Primary Care; Palliative Care in the Ambulatory Geriatric Practice; Choosing Cancer Therapy Based on Geriatric Assessment; and Emergency Medicine and Palliative Care.

This issue of Anesthesiology Clinics brings the reader up to date on the most important advances in surgical palliative care for anesthesiology intensivists. Topics covered include recent trends and developments, palliative care of patients on high doses of narcotics, trauma in the surgical ICU, care of family in the surgical ICU, communication skills in palliative surgery, surgical palliative care in Haiti, and much more.

Guest Editor Geoff Dunn presents a comprehensive look at surgical palliative care. Topics will include In-Patient Palliative Care Consultation and Surgery, Palliative Care in the Surgical Intensive Care Unit, Surgical Intensive Care and Bereavement, Palliative Surgical Oncology, The Palliative Surgery Discussion, Palliative Interventional Radiology, Palliative Care and Pediatric Surgery, Palliative Urology, Spiritual Dimensions of Surgical Palliative Care, Surgeons and Introspection, and much more

Palliative care focuses on reducing the severity of disease symptoms in order to prevent and relieve suffering and to improve the quality of life for people facing serious, complex illness. Primary care providers are often the coordinators of palliative care and need to be well versed in all aspects of providing palliative care. This issue covers important topics in palliative care, such as prognosis, management of several end-stage diseases, and management of severe symptoms. The issue could be helpful to a physician studying for subspecialty certification in hospice and palliative medicine.

A practical guide for understanding how palliative care can improve quality of life for patients and their caregivers. Robin Bennett Kanarek was a registered nurse working with patients suffering from chronic medical conditions when her ten-year-old son was diagnosed with leukemia. As her son endured grueling treatments, Robin realized how often medical professionals overlook critical psychological, emotional, and spiritual support for people with life-threatening illnesses. Living Well with a Serious Illness is the culmination of decades of Robin's work to advance the field of palliative care. Although palliative care is often associated with hospice and end-of-life planning, Kanarek argues for a more expanded definition that incorporates palliative care earlier in patients' journeys. Living Well with a Serious Illness helps patients and their caregivers understand • what palliative care entails • how to access the support they need when going through a serious illness • what questions to ask medical professionals • how to navigate advanced care planning • definitions of common terminology used with end-of-life planning • the importance of spiritual care, coping strategies, and emotional support • how to become an advocate for palliative care This book illuminates the importance of seeing patients as individuals who can benefit from care for their body, mind, and spirit—the core tenet of palliative care.

This book examines the ethics of end of life care, focusing on the kinds of decisions that are commonly made in clinical practice. Specific attention is paid to the intensification of treatment for terminal symptoms, particularly pain relief, and the withdrawal and withholding of care, particularly life-saving or life-prolonging medical care. The book is structured into three sections. The first section contains essays examining end of life care from the perspective of moral theory and theology. The second sets out various conceptual terms and distinctions relevant to decision-making at the end of life. The third section contains chapters that focus on substantive ethical issues. This format not only provides for a comprehensive analysis of the ethical issues that arise in the context of end of life care but allows readers to effectively trace the philosophical, theological and conceptual underpinnings that inform their specific interests. This work will be of interest to scholars working in the area as well as clinicians, specialists and healthcare professionals who encounter these issues in the course of their practice.

There is a growing conflict in medicine between the research imperative, with its implicit goal of overcoming death itself, and the re-emergent clinical imperative to treat death as a part of life, and to make the process of dying as tolerable as possible. Central to this conflict is the rise of scientific medicine and the decline of religious and associated moral discourses. Many of the Anglo Saxon countries are also marked by a moral and religious pluralism which breeds controversy over bioethical issues such as euthanasia.
It seems that modern medicine has put the cure of bodies before the care of persons. Some scholars attribute this to a metaphysical heritage of dualism and reductionism. This heritage has become problematic in the modern age when waning belief in a divine order leaves the individual self as the bearer of meaning. At the same time, knowledge about nature and society has been increasing at such an accelerated pace, it has become even more difficult to develop a unified secular worldview. When the dying self contemplates its own disintegration in this context, the search for meaning may rest heavy indeed.
Chapters one and two address these larger issues. Chapter three focuses on medicine's approach to cancer as a prime example of the strengths and weaknesses of the research imperative. Chapter four looks at the diffusion of the theory and practice of palliative care throughout the Anglo Saxon world. The fifth chapter discusses the development of effective pain control, essential to palliative care and one of modern medicine's unsung triumphs. The sixth chapter addresses the changing meaning of euthanasia in Western history in the past century, as ittransitioned from a philosophical position to a widely-debated policy proposal.
This book is for palliative care practitioners, and all health care professionals with an interest in end-of-life care. It is also for students in palliative care and the history of medicine, and for anyone interested in the history of this intriguing field.

This book encourages health professionals to reconceptualise their practice in the light of the fact that their patients are deteriorating and dying, supporting them in their dichotomous role which involves affirming that person's life whilst acknowledging that that life is ending. Professionals are encouraged to think laterally, to be creative in their use of their core skills, and to use their life skills and experience to change the focus of their interventions. By making these changes, those involved with caring for the dying will be able to address issues related to burnout and feeling de-skilled. The authors share their considerable experience with the reader - what works for both patient and carer/professional when working in this field. By providing workable solutions, they empower those in disempowering situations, such as when working with terminally ill children and adults. The book is truly holistic and client-centred in its approach, upholding the philosophy of palliative care. Aimed at all who interact with children and adults who have a life-limiting condition or who are dying Offers practical examples of approaches to dilemmas and emotional issues commonly face by those working in palliative care Encourages professionals to think laterally, to be creative in their use of core skills, and to use their life skills and experience to change the focus of their interventions Moves the emphasis away from the medical model to the emotional and spiritual influences on quality of life Offers clear, workable guidelines and demonstrates practical solutions, based on proven theory and experience, to problems encountered on a day-to-day basis by patients and those coming into contact with them