Although the need for improved care for dying patients is widely recognized and frequently discussed, few books address the needs of the physicians, nurses, social workers, therapists, hospice team members, and pastoral counselors involved in care. ""Care of the Dying Patient"" contains material not found in other sources, offering advice and solutions to anyone - professional caregiver or family member - confronted with incurable illness and death. Its authors have lectured and published extensively on care of the dying patient and here review a wide range of topics to show that relief of physical suffering is not the only concern in providing care. This collection encompasses diverse aspects of end-of-life care across multiple disciplines, offering a broad perspective on such central issues as control of pain and other symptoms, spirituality, the needs of caregivers, and special concerns regarding the elderly. In its pages, readers will find out how to: effectively utilize palliative-care services and activate timely referral to hospice; arrange for care that takes into account patients' cultural beliefs; and, respond to spiritual and psychological distress, including the loss of hope that often overshadows physical suffering. The authors especially emphasize palliative care and hospice, since some physicians fear that such referrals may be viewed by patients and families as abandonment. They also address ethical and legal risks in pain management and warn that fear of over prescribing pain medication may inadvertently lead to ineffective pain relief and even place the treating team at risk of liability for under treatment of pain. While physicians have the ability to treat disease, they also help to determine the time and place of death, and they must recognize that end-of-life choices are made more complex than ever before by advances in medicine and at the same time increasingly important. ""Care of the Dying Patient"" addresses some of the challenges frequently confronted in terminal care and points the way toward a more compassionate way of death.
David A. Fleming, M.D., MA, FACP is Professor and Chairman of the Department of Internal Medicine and Director of the Center for Health Ethics at the University of Missouri School of Medicine and Governor of the Missouri Chapter of the American College of Physicians. John C. Hagan III, M.D., is Editor of the journal Missouri Medicine and practices in Kansas City.