Physicians Guide to End-of-Life Care is the product of the American College of Physicians - American Society of Internal Medicine
End-of-Life Care Consensus Panel. Edited by Lois Snyder and Timothy Quill, the contributors include a number of well-known and respected names in the clinical field of palliative care. The book
sets out to provide a practical guide to palliative care for practising physicians - how to avoid or overcome the practical barriers to providing better end-of-life care, given the well documented
need for more palliative care, for more patients, earlier in the course of their terminal illness. In the Introduction, it is noted that continued acute, aggressive treatment of underlying disease
need not preclude good palliative care and that excellent treatment of pain, physical symptoms and other dimensions of suffering should be part of the treatment plan for all seriously ill patients
and not just those who are actively dying.
The book is divided into three sections. The first is about communication and relationship building and includes chapters
on Discussing Palliative Care with Patients, Decision Making, Cultural Differences, and Physician Roles and Responsibilities. These are focused, intensely practical chapters with illustrative
cases. The complementary nature of therapies directed at the underlying disease and palliative care is again emphasized. The chapter on when and how physicians should discuss palliative care
with patients even includes examples of what the doctor might say to open a discussion or reply to difficult questions from patients.
The second section of the book includes chapters on pain, depression, delirium, intractable suffering, and grief and bereavement.
These have been chosen as the major barriers to providing optimal end-of-life care and the discussions are very clinically orientated and practical. The chapter on intractable suffering discusses
the management of severe terminal suffering for physicians ethically and morally opposed to physician-assisted suicide.
The third section of the book is titled Legal, Financial and Quality issues. The chapters on legal and financial matters are
oriented very much to North America but the chapter by Joanne Lynn et al on quality issues is universally applicable and inspirational.
This excellent book does what it says and provides a practical, clinically-relevant guide to providing better palliative care,
addressing both physical symptoms and the other dimensions of suffering. It provides the practicing doctor with the clinical tools to provide better palliative care, including the situation where
the patient continues to have active therapy for the underlying disease. This book deserves to be read not only by those who work in palliative care, but by all physicians who look after patients
with serious, potentially life-threatening illnesses.
Highly recommended.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
March 2002
Author Information
Lois Snyder is Director, Center for Ethics and Professionalism, American College of Physicians – American Society of Internal Medicine, Philadelphia,
USA.
Timothy Quill is Professor of Medicine, Psychiatry, and Medical Humanities, University of Rochester School of Medicine, Rochester,
NY, USA.
Introducion xiii
Quill, Snyder
Section 1 The Interview and Relationship Building
1. Discussing palliative care with patients 3
Low, Quill, Tulsky
2. A consensus-based Approach to practicing palliative care for patients who lack decision-making capacity. 19
Karlawish, Quill, Meier
3. Respecting cultural differences at the end-of-life 35
Crawley, Marshall, Koenig
4. Beyond Symptom Management: Physician roles and responsibility in palliative care
Byock, Caplan, Snyder 56
Section II Pain, Depression, Delirium, and Intractable Problems
5. Management of Pain and spinal cord compression in patients with advanced cancer
Abrahm 75
6. Assessing and managing depression in the terminally ill patient 101
Block
7. Diagnosis and management of delirium near the end of life 124
Casarett, Inouye
8. Dying patients in the intensive care unit: forgoing treatment and maintaining care
Faber-Langendoen, Lanken 139
9. Responding to intractable suffering: the role of terminal sedation and voluntary refusal of food and fluids 159
Quill, Byock
10. Life after death: A practical approach to grief and bereavement 178
Casarett, Kutner, Abrahm
Section III Legal, Financial and Quality Issues
11. Legal barriers to end-of-life care: myths, realities and grains of truth 197
Meisel, Snyder, Quill
12. Financing care for those coming to the end-of-life 214
Lynn, Wilkinson, Etheredge
13. Reforming care for those near the end of life: the promise of quality improvement
Lynn, Nolan, Kabcenell, Weissman, Milne, Berwick 234
Index 253
