"There is an unspoken dark side of American medicine--keeping patients alive at all costs. Two thirds of Americans die in healthcare institutions tethered to machines and tubes, even though research indicates that most prefer to die at home in comfort, surrounded by loved ones. The question How do you want to live? must be posed to the seriously ill because they deserve to choose. If doctors explain options--including the choice to forego countless medical interventions that are often of little benefit--then patients can tell doctors how they wish to spend the remainder of their lives. A doctor's heroic efforts to prolong a life can instead prolong that patient's death, and these traumatic measures also bankrupt the healthcare system. One third of the Medicare budget is spent on the last six months of life, often on technological interventions that are not helpful and inflict more suffering. Through the stories of six patients and six very different end-of-life experiences, Volandes explores the trajectory of events and treatments that occur with and without this essential conversation. He argues for a radical re-envisioning of the patient-doctor relationship--including videos to spark discussions--and offers ways for patients and their families to talk about this difficult issue to ensure that patients will be at the center and in charge of their medical care"--Provided by publisher.
Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering. Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.
From rites to rights of passage : ideals, politics, and the evolution of the American hospice movement / Joy Buck -- Hospice care as a moral practice : exploring the philosophy and ethics of hospice care / Timothy W. Kirk -- The pharmacist as an integral member of the hospice interdisciplinary team / R. Timothy Tobin -- The continuingly evolving role of the hospice medical director / Joan Harrold -- The interdisciplinary team integrating moral reflection and deliberation / Terry Altilio and Nessa Coyle -- Ethical issues in the care of infants, children, and adolescents / Marcia Levetown and Stacy Orloff -- The patient-family dyad as interdependent unit of hospice care : toward an ethical justification / Patrick T. Smith -- Inpatient hospice care : organizational and ethical considerations / Tara Friedman -- Ethical issues associated with hospice in nursing homes and assisted living communities / Jean C. Munn and Sheryl Zimmerman -- Cardiopulmonary resuscitation in hospice : ethically justified or an oxymoron? / Muriel R. Gillick -- Moral meanings of physician-assisted death for hospice ethics / Courtney S. Campbell -- Ethics committees for hospice : moving beyond the acute care model / Jennifer Ballentine and Pamela Dalinis -- Design for dying : new directions for hospice and end-of-life care / Bruce Jennings.
