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Care of the Dying Patient

Edited by David A. Fleming & John C. Hagan III

Publication Year: 2010

Although the need for improved care for dying patients is widely recognized and frequently discussed, few books address the needs of the physicians, nurses, social workers, therapists, hospice team members, and pastoral counselors involved in care. Care of the Dying Patient contains material not found in other sources, offering advice and solutions to anyone—professional caregiver or family member—confronted with incurable illness and death. Its authors have lectured and published extensively on care of the dying patient and here review a wide range of topics to show that relief of physical suffering is not the only concern in providing care.
            This collection encompasses diverse aspects of end-of-life care across multiple disciplines, offering a broad perspective on such central issues as control of pain and other symptoms, spirituality, the needs of caregivers, and special concerns regarding the elderly. In its pages, readers will find out how to
  • effectively utilize palliative-care services and activate timely referral to hospice
  • arrange for care that takes into account patients’ cultural beliefs
  • respond to spiritual and psychological distress, including the loss of hope that often overshadows physical suffering
            The authors especially emphasize palliative care and hospice, since some physicians fear that such referrals may be viewed by patients and families as abandonment. They also address ethical and legal risks in pain management and warn that fear of overprescribing pain medication may inadvertently lead to ineffective pain relief and even place the treating team at risk of liability for undertreatment of pain.
            While physicians have the ability to treat disease, they also help to determine the time and place of death, and they must recognize that end-of-life choices are made more complex than ever before by advances in medicine and at the same time increasingly important. Care of the Dying Patient addresses some of the challenges frequently confronted in terminal care and points the way toward a more compassionate way of death.

Published by: University of Missouri Press


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p. C-C

Title Page, Copyright, Dedication

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pp. i-vi


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pp. vii-viii

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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...


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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


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pp. 151-154

Back Cover

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p. BC-BC

E-ISBN-13: 9780826272218
E-ISBN-10: 0826272215
Print-ISBN-13: 9780826218902
Print-ISBN-10: 0826218903

Page Count: 176
Publication Year: 2010

Edition: 1