The philosophy of palliative care : critique and reconstruction / Fiona Randall, R.S. Downie.

Format:

Book

Author/Creator:

Randall, Fiona.

Contributor:

Downie, R. S. (Robert Silcock)

Class of 1932 Fund.

Language:

English

Subjects (All):

Palliative treatment--Philosophy.

Palliative treatment.

Palliative treatment--Moral and ethical aspects.

Palliative Care--ethics.

Philosophy, Medical.

Philosophy.

Medical Subjects:

Palliative Care--ethics.

Philosophy, Medical.

Physical Description:

xiv, 236 pages ; 24 cm

Place of Publication:

Oxford ; New York : Oxford University Press, 2006.

Summary:

The idea of a philosophy of palliative care emerged with Cicely Saunders' vision for 'a good death', and was developed further with the WHO definition of palliative care. It is now being applied not only to cancer patients, but to all patients in end of life situations. As this 'palliative care approach' model advances, it is important to pause and comment on its effectiveness. It is a philosophy of patient care, and is therefore open to critique and evaluation.

Using the Oxford Textbook of Palliative Medicine Third Edition as their basic reference, Randall and Downie present their argument that the palliative care approach has become too busy and over-professionalised, and that it therefore has significant weaknesses. They examine the framework of the specialty - quality of life, autonomy, dignity, patient-centredness, and the priority assigned to relatives in the remit of care - and the moral problems associated with implementing such a philosophy. The resource implications of various health care policies are also discussed in relation to the WHO definition.

The contradictions of palliative care literature come under scrutiny as the gulf between the rhetoric and the clinical application of its theory is discussed. Whilst the authors defend the achievements of palliative care and those who work in the profession, they present suggestions for an alternative philosophy. In order for palliative care to evolve, it must return to its original simplicity The reconstruction proposed in this text is fascinating reading and prompts many ethical and philosophical questions about the future of palliative care.

Contents:

Part 1 Framework and concepts

1 Roots, traditions, and philosophy 3

Introduction and aims 3

1.1 Roots and traditions 5

1.2 Two traditions of health care 7

1.3 Consumerism in health care 9

1.4 Critique 10

1.5 A 'philosophy'of palliative care 10

1.6 The normative function of a philosophy of palliative care 12

1.7 Theoretical questions 13

1.8 Practical questions: ethics 14

1.9 Paradoxes in palliative care 19

2 Quality of life 25

2.1 The use of the term 'quality of life' 27

2.1.1 Qualities, evaluations, and definability 27

2.1.2 The global sense of quality of life 29

2.1.3 Health-related quality of life 31

2.2 Assessment and measurement of quality of life 35

2.2.1 Theory of measurement and quality of life 35

2.2.2 Weighting and summing scale items 40

2.2.3 Utility rating scales 42

2.2.4 Should quality of life be represented as numerical data? 43

2.3 Decision-making for individual patients 44

2.4 Quality of life as the goal of palliative care? 48

3 Autonomy, dignity, respect, and the patient-centred approach 53

3.1 Autonomy, dignity, and respect in Kant 53

3.2 Developing Kant's ideas: a bad way and a good way 55

3.3 Truth-telling, information giving, dignity, and autonomy 56

3.4 Consent, autonomy, and dignity 59

3.5 Professionalism, and consent as patient self-determination 61

3.6 Consumerism, patient self-determination, and consent 62

3.7 Human Rights, consent, and patient self-determination 64

3.8 Patient-centredness, consent, and self-determination 65

3.9 Dignity and self-determination 67

3.10 The analysis of dignity 69

4 Relatives 75

4.1 Patient, family, and conflict of interest 78

4.1.1 Conflicts over confidentiality 80

4.1.2 Conflicts over place of care and death 80

4.1.3 Conflicts over time of death 82

4.2 Bereavement care: benefit or harm? 84

4.3 Cost effectiveness of benefit to relatives 88

4.4 The nature and extent of obligations to relatives 90

Part 2 Interventions, effectiveness, and cost

5 Control of symptoms and prolongation of life 97

5.1 Relief of physical symptoms and improvement of function 98

5.2 Treatments which may prolong life 100

5.2.1 Prolonging death or prolonging life? 100

5.2.2 Withholding and withdrawing life-prolonging treatment 104

5.3 Treatments which may hasten death 106

5.3.1 Not hastening death or not intending to hasten death? 107

5.3.2 Killing versus letting die: the issue of causation 108

5.3.3 Intending versus foreseeing death 111

5.3.4 Double effect 112

5.3.5 Euthanasia and letting die 115

5.4 The roles and responsibilities of patients and professionals 117

6 Resuscitation and advance statements 125

6.1 CPR: a life-prolonging treatment 126

6.2 CPR compared with other life-prolonging treatments 128

6.2.1 The 'nothing to lose' argument 129

6.2.2 The 'symbolic value' argument 131

6.2.3 The 'low cost' argument 132

6.3 CPR decisions and competent patients 133

6.4 CPR decisions and incompetent patients 136

6.5 Positive recommendations for CPR decision-making 136

6.6 Advance statements 138

6.7 Arguments in favour of advance statements 138

6.7.1 Giving patients what they want 138

6.7.2 Facilitating best interests judgements 139

6.7.3 Making life easier for the family 140

6.7.4 Avoiding waste of resources 240

6.8 Arguments against advance statements 141

6.8.1 Difficulties of interpretation and enactment 141

6.8.2 Best interests and the duties of doctors 142

6.8.3 Advance statements and family problems 145

6.8.4 Advance statements and resources 145

6.8.5 Additional problems 146

6.9 Advance statements and the philosophy of palliative care 146

7 Assessment and treatment of psychosocial and spiritual problems 149

7.1 Psychosocial and spiritual problems as health care responsibility 149

7.1.1 The patient-professional relationship 151

7.1.2 Effect of the recommended relationship on the patient 154

7.1.3 The effect of the recommended relationship on the professional 160

7.1.4 Benefits versus harms of the relationship 162

7.1.5 An alternative: the client-counsellor relationship 165

a Empathy 169

b Respect 172

c Genuineness 173

7.2 Psychosocial and spiritual care: an alternative approach 175

8 Resource allocation 183

8.1 Needs assessment 184

8.2 Efficiency 189

Part 3 Critique and reconstruction: some suggestions for a better way

9 Critique and reconstruction: some suggestions for a better way 199

9.1 Palliative care as a specialty 199

9.2 The Asklepian model of holistic care 201

9.2.1 Asklepian attention 201

9.2.2 Asklepian attention and Hippocratic observation 203

9.3 Asklepian acceptance and spirituality 205

9.4 Honest hope 209

9.5 Personal and professional development 213

9.6 Teams 218

9.7 The desirability of a philosophy of palliative care 219

9.8 Towards a new philosophy 220

9.9 A new philosophy statement 224.

Notes:

Includes bibliographical references and indexes.

Local Notes:

Acquired for the Penn Libraries with assistance from the Class of 1932 Fund.

ISBN:

0198567367

OCLC:

61860832

Publisher Number:

9780198567363