Preface |
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xi | |
Acknowledgments |
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xvi | |
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1 The Conundrum: How Much Medical Care Is `Enough'? |
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1 | (16) |
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Life Expectancy, Health Status and Health Care Spending |
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3 | (4) |
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Quality and Utilization of Medical Care at the End of Life |
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7 | (8) |
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What is the Goal and How Might We Get There? |
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15 | (2) |
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2 The US Health Care `System': The Good, the Bad, and the Probably Unfixable |
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17 | (20) |
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Health Insurance and Payment --- the US `System' |
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18 | (2) |
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Sources of Health Insurance Coverage |
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20 | (1) |
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Health Care Payment, Incentives for Overutilization, and Quality of Care |
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21 | (3) |
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Health Care Access and Payment -- the Canadian System |
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24 | (2) |
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Health Care Access and Payment -- the National Health Service in the United Kingdom |
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26 | (2) |
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28 | (3) |
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Informed Consent and End-of-Life Law in the United States |
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31 | (2) |
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Informed Consent and End-of-Life Law in Canada |
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33 | (1) |
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Informed Consent and End-of-Life Law in the United Kingdom |
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34 | (1) |
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Assessing the Possibility of Future Reform |
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35 | (2) |
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3 Autonomy and Informed Consent in the Real World |
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37 | (37) |
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Pathways to Death and Decisional Opportunities |
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38 | (3) |
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Autonomy and Beneficence: Two Fine Words in Search of Meaning |
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41 | (4) |
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Autonomy in the Real World |
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45 | (6) |
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Informed Consent Law and Practice -- Papering Over Poor Communication |
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51 | (6) |
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The Reality of Physician-Patient Communication |
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57 | (8) |
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Yet Another Challenge: Statistics and Innumeracy |
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65 | (3) |
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68 | (1) |
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The Impact of Race and Racism |
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69 | (3) |
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`Doing Everything' Versus Trying for `Just Right' |
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72 | (2) |
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4 The Denial of Death and Its Sequelae |
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74 | (13) |
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Cultural Indicia of the Fear of Death |
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78 | (4) |
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The Impact of Death Denial on Life |
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82 | (4) |
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To Be a Rock and Not to Roll |
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86 | (1) |
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5 Disorders of Consciousness and the Meaning of Life |
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87 | (20) |
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The Permanent Vegetative State |
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90 | (2) |
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92 | (2) |
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94 | (2) |
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96 | (2) |
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Some Comparisons and Observations |
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98 | (6) |
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Can We Agree to Disagree? |
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104 | (3) |
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6 More Barriers to Good Communication |
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107 | (24) |
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Communication Avoidance and Its Causes |
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108 | (5) |
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Physician Professional Culture -- the `Do Everything' Mentality |
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113 | (3) |
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By the Way, a Word About How Physicians Die |
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116 | (2) |
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Financial Incentives and the Business of Medicine |
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118 | (5) |
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123 | (6) |
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129 | (2) |
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7 Palliative and Hospice Care: Misunderstandings and Lost Opportunities |
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131 | (22) |
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134 | (3) |
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The Benefits of Palliative and Hospice Care |
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137 | (2) |
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Structural Barriers to Access and Utilization of Palliative Care and Hospice |
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139 | (3) |
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Once again, Honest Communication Really Matters |
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142 | (6) |
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A `Better' Death in Britain? |
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148 | (2) |
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Palliative and Hospice Care are Medical Care |
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150 | (3) |
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8 Rational Apathy and the Role of Uncertainty |
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153 | (25) |
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Knightian Uncertainty, Clinical Uncertainty, and Cognitive Biases |
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154 | (8) |
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162 | (3) |
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Activist and Passivist Patients and Physicians |
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165 | (9) |
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174 | (2) |
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176 | (2) |
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9 The Crucible: Making Decisions for Incapacitated Patients |
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178 | (22) |
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The Basics of Surrogate Decision-Making Law and Ethics |
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180 | (3) |
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Why Surrogate Decision-Making is so Difficult |
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183 | (4) |
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The Limitations of Advance Directives |
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187 | (6) |
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The Extra Layers of Clinical and Ethical Uncertainty |
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193 | (5) |
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Race and Surrogate Decision-Making |
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198 | (1) |
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With Caring Comes Courage |
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198 | (2) |
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10 Resolving Conflicts at the End of Life |
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200 | (15) |
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The United States: Hospital Ethics Committees and Judicial Resolution |
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201 | (3) |
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Canada: Ontario's Consent and Capacity Board |
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204 | (6) |
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England and Wales: The Mental Capacity Act |
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210 | (3) |
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Patient Preferences, With a Dose of Best Interests |
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213 | (2) |
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215 | (25) |
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The Feasibility of System-Wide Changes |
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216 | (2) |
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218 | (1) |
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The Communication Conundrum |
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219 | (9) |
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Some Promising Developments |
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228 | (6) |
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Forcing Physicians to have `The Talk' |
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234 | (1) |
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An Opportunity for Physicians |
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235 | (3) |
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238 | (2) |
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240 | (6) |
Index |
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246 | |