For thousands of years, Western culture has dichotomized science and art, empiricism and subjective experience, and biology and psychology. In contrast with the prevailing view in philosophy, neuroscience, and literary criticism, George Engel, an internist and practicing physician, published a paper in the journal Science in 1977 entitled "The Need for a New Medical Model: A Challenge for Biomedicine." In the context of clinical medicine, Engel made the deceptively simple observation that actions at the biological, psychological, and social level are dynamically interrelated and that these relationships affect both the process and outcomes of care. The biopsychosocial perspective involves an appreciation that disease and illness do not manifest themselves only in terms of pathophysiology, but also may simultaneously affect many different levels of functioning, from cellular to organ system to person to family to society. This model provides a broader understanding of disease processes as encompassing multiple levels of functioning including the effect of the physician-patient relationship. This book, which contains Engel's seminal article, looks at the continuing relevance of his work and the biopsychosocial model as it is applied to clinical practice, research, and education and administration. Contributors include: Thomas Inui, Richard Frankel, Timothy Quill, Susan McDaniel, Ronald Epstein, Peter Leroux, Diane Morse, Anthony Suchman, Geoffrey Williams, Frank Degruy, Robert Ader, Thomas CampbelL, Edward DecI, Moira Stewart, Elaine Dannefer, Edward Hundert, Lindsey Henson, Robert Smith, Kurt Fritzsche, Manfred Cierpka, Michael Wirsching, Howard Beckman, and Theodore Brown.

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

"When it is our time, is there any one of us who would not hope for a gentle ending to our lives and a peaceful death? Yet for many, this longing remains elusive. Fears and apprehensions cloud our understanding of what is involved in the ""getting there."" Many of us choose not to think about death or even consider preparing for this second of our universal human experiences. This death-unease can lead to our avoiding being with a dying family member or friend, sadly missing the precious chance to say goodbye. It may also prevent us from taking on the challenging but vastly rewarding role of caregiver. It is important to know you do not have to be alone.These lessons, learned from the dying themselves, will show you how the final journey--lived fully--can be the most extraordinary of your life. And yes, your goodbyes can be blessed in ways you could never have imagined."