Foreword
Preface
Acknowledgements
Permissions
PartI: Death and Dying in Context
Ch 1: Medical Students, Residents and the Dying Patient
The Challenge of Caring for the Dying
Goal-Setting Near the End of Life
How this Book is Organized
Closing Words
Ch 2: The Rise of the Bioethics and Palliative Care Movements
European Origins of Hospice and Palliative Care
The American Context
The Rise of Self-Determination
Towards an Ethic of Patients' Rights
Ch 3: Death, Dying, and the Law
The Law and the Rise of Patient Self-Determination
Quinlan and the Right to Die
Quinland and the Institutionalization of Hospital Ethics Committees
Cruzan and the Patient Self-Determination Act
Advance Care Planning in Theory and Practice
From Self-Determination to Physician-Assisted Suicide
Physician-Assisted Suicide: Laying Out the Arguments
Physician-Assisted Suicide in the Courts
A Consensus on Palliative Care
Back to the Future: The Schiavo Case
Epilogue
Ch 4: End-of-Life Care in the Hospital
Death in the Modern Hospital
Medical Rescue and Intensive Care
Fostering Communication
Communication, Palliation, and the Road Not Taken
Milestones at the End-of-Life
Ambivalence and Medical Futility
Futility: A Definitional Primer
The Evolution of Futility Disputes
Goal Convergence, Palliative Care and the Avoidance of Futility Disputes
Part II: Goal-Setting: A Strategy for Effective Palliative Care
Ch 5: Goals of Care: Triggering the Process
Goal-Setting as Differential Diagnosis
Triggering the Process
Concluding Comments
Ch 6: Goals of Care: When Death is Near
Introduction
Clinical Perceptions
Patient Perceptions
When a Patient Wants to Die
Surrogate Perceptions
Decision-Making Capacity
Helping Surrogates Decide
Ch 7: Goals of Care: End-of-Life Decisions
Introduction
Do Not Resuscitate Orders
Advance Care Planning
Working with the Proxy
Withdrawals of Care
Hospice or Palliative Care Referral
Hospice Care
Ch 8: Goals of Care: Medical Developments
Introduction
A Life-Threatening Illness
Prognosis
Acute Decompensation and the Use of Life-Sustaining Therapies
Consideration of ICU Transfer
Symptoms at the End of Life
The Ethics of Opioid Use
Ch 9: Goals of Care: Gathering Information
Introduction
Sources of Information
Demographics and Local Culture
The Power of Diagnosis
Forced Prognostication and Patient Expectations
Assessment of Capacity and the Refusal of Life-Sustaining Therapies
Knowledge of Diagnosis and Prognosis
Constructing a Shared World Meaning with the Patient and Family
Breaking Bad News
The Therapeutic Exception
DNR in the OR
The Elusive Advance Directive
Family Dynamics
The Symbionic Family
Cultural Issues: Religious Objections to Brain Death
Public Perspectives on Pain and Meaning
Biological Symptom Assessment
Ch 10: Formulating the Goals of Care
Introduction
Defining Goals
Hospital Resources
Psychiatry Consultation
Pastoral Care/Chaplaincy
Pain Service/Palliative Care Consult/Referral to Palliative Care Unit
Hospice Referral
Social Work
Ethics Committees
The Centrality of Communication and Consensus
Working with Nurses
Involving the Patient and Family
One Good Death
Appendix: The Goals of Care Assessment Tool (GCAT)
Index
