Cover

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pp. C-C

Title Page, Copyright, Dedication

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pp. i-vi

Contents

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pp. vii-viii

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Foreword

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pp. ix-xii

For centuries, care of the dying was an occasion for compassion, empathy, ritual, and prayer, not an exercise in ethical decision making. Most cultures possessed customs, symbols, and religious practices designed to provide comfort and solace to dying people and their families. Any...

Acknowledgments

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pp. xiii-xvi

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Introduction - David A. Fleming and John C. Hagan III

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pp. 1-6

More than two million Americans die every year. Healthcare providers are therefore forced daily to confront often agonizing decisions that must be made for dying patients. Patients and their families face difficult choices about the “quality of death” that dying will have and the kind of care ...

Part 1: Control of Suffering

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1. Pain Management at the End of Life - Clay M. Anderson

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pp. 9-16

Pain is a universal aspect of life and part of our sensory experience. It is necessary and adaptive. At the same time, it is a form of suffering that can affect the duration and detract from the quality of human life. Currently, there are both pharmacologic and nonpharmacologic tools that allow...

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2. Relieving Pain: Today’s Legal and Ethical Risks - David A. Fleming

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pp. 17-29

In June 2001, a California jury found an internist liable for reckless neglect in undertreating a dying man’s pain and ordered the physician to pay $1.5 million to his patient’s surviving family members.1 The finding of negligence in this case was not due to improper diagnosis or treatment of...

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3. Relieving Non-pain Suffering at the End of Life - Clay M. Anderson

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pp. 30-42

The term disease implies both a pathologic biological process in a person and a burden of suffering upon the person. It is considered an obligation of the compassionate physician and health-care team not only to treat disease, but also to manage symptoms in order to minimize suffering and ...

Part 2: The Needs of Special Populations

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4. Questions and Answers about Hospice: A Guide for Physicians - Steven Zweig and Paul Tatum

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pp. 45-57

The idea that dying is a natural part of life conflicts with the medicalization of death to which we have become accustomed. 1 However, all would agree that it would be inappropriate to treat only the disease of the dying patient. We would be remiss to ignore the familial, social, cultural, and...

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5. The Burden of Caregiving at the End of Life - David A. Fleming

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pp. 58-67

Patients with terminal illnesses typically require the assistance of family members, significant others, and friends to avoid hospitalization and be allowed to die at home. Nonprofessional caregivers are of central importance in end-of-life care because of the ongoing, day-to-day, often...

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6. Older Patients and Their Families Make Decisions about End-of-Life Care - Steven Zweig and David R. Mehr

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pp. 68-83

Most people who live to old age die from chronic disease. Three chronic diseases are the leading causes of death in people over age sixty-five: cancer, heart disease, and cerebrovascular disease. Following these are chronic and acute lower-respiratory diseases, diabetes, and Alzheimer’s-type...

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7. Cultural Sensitivity in End-of-Life Discussions - David A. Fleming

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pp. 84-98

Encounters between physicians and patients of different cultures are increasingly common in today’s diverse society. The need for cultural awareness by health-care providers is therefore becoming more important. This is especially true in end-of-life discussions, where cultural ...

Part 3: Psychological and Spiritual Needs

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8. Redefining Hope for the Terminally Ill - Debra Parker Oliver

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pp. 101-114

Although Kübler-Ross recognized the peace that comes to the dying and the rewards experienced by those working with them, society still struggles to understand how anything positive can be experienced once death is imminent....

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9. Spirituality and End-of-Life Care - Scott E. Shannon and Paul Tatum

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pp. 115-127

Prior to the modern medical era, spiritual issues were central to care of the dying. During the fourth century AD, hospices founded by religious orders for pilgrims and travelers became centers to care for the sick. The core values of these hospices are often attributed to the Gospel of Matthew, ...

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10. The Path Ahead: Difficult Lessons for Physicians and Society - David A. Fleming

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pp. 128-144

Identifying goals of treatment and expressing preferences through advance planning and documentation of it are increasingly important for patients with terminal illness, but accomplishing this is often difficult. This is particularly true for caregivers and patients of advancing age, who...

Notes on the Contributors

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pp. 145-150

Index

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pp. 151-154

Back Cover

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pp. BC-BC