DOI: https://doi.org/10.20529/IJME.2007.015
Palliative care is now established as a speciality in many advanced countries. Painstaking work some 30 years ago changed the connotation of what was then practised as terminal care. Besides cancer, such care now encompasses symptom control in patients with other chronic conditions like multiple sclerosis. The practice of this kind of care involves many ethical challenges in terms of its legal, social, and fiscal aspects. The book under review discusses the ethical issues in the management of persons with chronic illnesses.
Almost all systems of medicine have attempted to formulate an ethical code of practice. Four cardinal principles guide the ‘ethics of care’ — doing good, causing no harm, ensuring justice, and respect for the patient’s autonomy. This involves asking such questions as: Does a patient need admission? Should intravenous fluids be provided when the end is near? Should the relatives or the patient be told? These perplexing issues throw up challenges that a generalist may not be able to handle. Each issue needs to be treated according to the specific case. There are no definitive answers.
Respect for the patient’s wishes and the benefits of a proper discussion constitute critical decision-making. The author discusses this topic in a chapter and writes that this involves a four-step protocol: an interview with the patient, a review of the available options, an evaluation of their benefits and risks, and verification and validity.
Patients with advanced cancer may receive curative, palliative or terminal care. Caring is part of the cure. A chapter on caring and curing examines the impact of the disease in terms of its emotional, social and spiritual aspects. It examines the need of integrating palliative care during the earlier stages of the disease. A caring model involves a patient-caregiver partnership that could lead to an optimal low tech-high touch care.
The caregiver also faces the challenge of conveying bad news. A chapter deals with the difficult distinction between honesty and unintentional deception, disinformation, lying and truth and how it impacts the patient-caregiver relationship. Should you be honest and make a blunt disclosure? Or provide false assurances? How do you resolve the dilemma of using the professional power of a doctor as well as attending to the vulnerability of the patient’s uncertain future?
The book uses the views of eight professionals and a mix of theoretical arguments and cases to discuss the numerous challenging issues in palliative care. Some of the arguments may require a second reading, especially if one is new to palliative care. The book could be useful for students and for persons working in the fields of care giving, law, and religion because of its insights into a set of complex issues.