End of Life Choices: Consensus and Controversy
ISBN: , SKU: , AUTHOR: Randall, Fiona / Downie, R. S., PUBLISHER: Oxford University Press, Palliative care is undergoing a period of rapid change, both in perceptible ways such as legislation, policy, and clinical guidelines, but also in its philosophy and ethics. There is ambiguity surrounding even the definitions used, ranging from palliative care, to supportive care, to end of life care. Randall and Downie propose that the uncertainties in the current thinking on end of life care may change the two ethical (and legal) principles on which modern medical care has been built--that practitioners must obtain the informed consent of the patient for treatment, and that practitioners must seek the best health interests of their patients. They examine a wide range of issues, themes, and contradictions prevalent in modern palliative/end of life care. These include: choice, assisted suicide, roles and values, responsibility, rights, Advance Care Plans, withdrawal and withholding of treatment, advocacy, the Mental Capacity Act, best interests, definitions, and the new Department of Health End of Life Care Strategy. Split into two section, End of Life Choices: Consensus and Controversies provides guidance through the ethical minefield that has developed for doctors and nurses who care for patients towards the end of life. The first section discusses some of the issues of end of life care as they are still widely encountered by GPs, nurses, and hospital clinicians. It presents a mainly consensus view on patient choice, consent, life-prolonging treatment, and symptom relief, including sedation. The second section discusses some current controversies, such as advance care planning, preferred place of care and death, physician assisted suicide, and extended ideas of "best interest," including the idea that there are therapeutic duties to the relative of patients. Additional online resources outline the common ethical theories and the vocabulary used in ethical theory which is useful for readers who are taking part in training courses.