Clinical Medicine

No specialty faces more diverse and challenging ethical dilemmas than palliative medicine. What is the best way to plan ahead for the end of life? How should physicians respond when patients refuse treatments likely to be beneficial or demand treatments not likely to be? Who makes medical decisions for patients who are too ill to decide for themselves? Do patients have the “right to die” (and, if so, what exactly does that mean)? Other ethics texts have explored these issues but often from an academic perspective that overlooks the practical realities of clinical medicine. Conversely, medical textbooks frequently lack sufficient philosophical depth to fully explore the complexities of these issues. This complete guide to the ethics of palliative care combines clinical experience with philosophical rigor to provide a comprehensive analysis of this fascinating field. Using relevant case studies, core subjects such as intensive symptom management at the end of life, physician-assisted dying, and palliative sedation are examined from historical, legal, clinical, and ethical perspectives. Whereas pediatric issues are often an afterthought in palliative care textbooks, this guide explores the unique nature of ethical dilemmas in the prenatal, neonatal, and adolescent age groups. Other important topics such as neuro-palliative care, organ donation, research, and moral distress are also covered in detail. Written with clinical nuance for medical professionals—and clear language as well as a glossary for lay readers—this guide offers all readers an opportunity to explore and understand the fascinating ethical issues facing patients suffering from life-threatening illness.Less

Spiritual sickness troubles American medicine. Through a death-denying culture, medicine has gained enormous power—an influence it maintains by distancing itself from religion and spirituality, which too often remind us of our mortality. As a result of this separation of medicine from spiritual traditions, patients facing serious illness infrequently receive adequate spiritual care despite the large body of empirical data demonstrating its import to patient meaning-making, quality of life, and medical utilization. This secular–sacred divide also unleashes depersonalizing social forces through the market, technology, and legal-bureaucratic powers that reduce clinicians to tiny cogs in an unstoppable machine. Hostility to Hospitality is one of the first books of its kind to explore these hostilities threatening medicine and offer a path forward for the partnership of modern medicine and spirituality. Drawing from interdisciplinary scholarship including empirical studies, interviews, history and sociology, theology, and public policy, the authors argue for structural pluralism as the missing piece to changing hostility to hospitality.Less