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E-raamat: Intimations of Mortality: Medical Decision-Making at the End of Life

  • Formaat: PDF+DRM
  • Ilmumisaeg: 17-Mar-2022
  • Kirjastus: Cambridge University Press
  • Keel: eng
  • ISBN-13: 9781108804608
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  • Formaat: PDF+DRM
  • Ilmumisaeg: 17-Mar-2022
  • Kirjastus: Cambridge University Press
  • Keel: eng
  • ISBN-13: 9781108804608
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In Intimations of Mortality, Barbara Reich offers an empirically-based critique of the failures of end-of-life communication and decision-making in the United States. Using England and Canada as occasional foils, Reich explores why U.S. physicians, patients, and families struggle to have the conversations necessary to provide seriously ill and dying patients with medical care consistent with their preferences. Reich also shows how a number of different factors including payment mechanisms, liability fears, cultural phenomena, communication avoidance, death denial, and clinical uncertainty impact physician-patient communication and medical decision-making, leave patients and families without the tools they need to make informed choices, and instead leave the default practices in place. Ultimately, this groundbreaking analysis unveils the interconnectedness of the many obstacles to better communication and decision-making in end-of-life communications and offers much-needed suggestions for improvement.

Arvustused

'We are not good at talking about death. It's seen as embarrassing, awkward. We don't have the words or conventions. In her brilliant book, Intimations of Mortality: Medical Decision-Making at the End of Life, Barbara A. Reich explains how to talk about death well. Beautifully written, full of humanity and gentleness, the book draws from law, literature, philosophy and the experience of a life well lived to show us how doctors, patients and families can have the conversations they should have about death and the legal framework that can make them possible. This is a hugely important topic. We must do death better, and Reich offers a way of doing this.' Jonathan Herring, DM Wolfe-Clarendon Fellow in Law, Exeter College, University of Oxford 'An essential read for all those who seek to improve end-of-life decision-making exposing the barriers to good and necessary communication, it enables us to dismantle them and ensure better deaths for ourselves and others.' Jocelyn Downie, James S. Palmer Chair in Public Policy and Law, Dalhousie University 'Professor Barbara Reich has written a thoughtful book to help us 'think well' about death and dying. The author moves from personal stories to the law, from medical dilemmas of brain death and vegetative states to mechanisms like boards and ethics committees to aid medical, family, and ethics decisionmakers. A pleasure to read, this book is perfect for academics and the general public alike.' Barry R. Furrow, Professor of Law, Drexel University Thomas R. Kline School of Law 'This insightful, clinically relevant volume does reveal the challenges and obstacles related to the quality of end-of-life care in the US. It should be read by all palliative care physicians, hospice social workers and chaplains, and those seeking a clinically applicable understanding of end-of-life care Recommended.' A. W. Klink, Choice

Muu info

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