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List of abbreviations and acronyms | p. xv |
Introduction | p. xvii |
Patient choice and consent | p. 3 |
Choice: the traditional concept | p. 4 |
Consumer choice, the free market and the health service | p. 6 |
Some problems with consumerism in end of life care | p. 7 |
Competition | p. 8 |
Prevention from harm | p. 10 |
Alternatives | p. 11 |
Responsibility | p. 12 |
Money | p. 13 |
Implications of a system for end of life care based on consumerism | p. 13 |
Consent | p. 13 |
The concept of a profession | p. 14 |
Motivation | p. 15 |
The art of dying lost by consumerism | p. 16 |
The roots of the choice agenda | p. 17 |
Conclusions | p. 19 |
References | p. 20 |
Choice and best interests: clinical decision-making in end of life care | p. 23 |
Understanding the clinical problem | p. 24 |
Selecting the treatment options which offer a prospect of net benefit | p. 25 |
Assessment of capacity | p. 28 |
Making the final decision with patients who have capacity: consent | p. 32 |
How much information? | p. 33 |
The continuing request for what is clinically inappropriate | p. 40 |
A right to consent or a duty to do so? | p. 41 |
Making the final decision: patients without capacity | p. 41 |
Conclusions | p. 46 |
References | p. 46 |
Three logical distinctions in decision-making | p. 49 |
Intended and foreseen consequences: doctrine of double effect | p. 49 |
Acts and omissions | p. 52 |
Killing and letting die | p. 54 |
Conclusions | p. 59 |
References | p. 59 |
Choice and best interests: life-prolonging treatments | p. 61 |
Preliminary issues of ethical importance | p. 62 |
Understanding the clinical problem | p. 67 |
Selecting treatment options that offer a prospect of net benefit | p. 67 |
Making the final decision with patients who have capacity | p. 70 |
Disclosure of information | p. 70 |
Patients requesting clinically inappropriate treatments | p. 75 |
Reviewing the decision | p. 76 |
Life-prolonging treatments and advance care planning | p. 77 |
Making the final decision: patients without capacity | p. 77 |
Special features of decision-making regarding life-prolonging treatment | p. 78 |
Consulting the patient | p. 79 |
Consulting those close to the patient | p. 79 |
The basis of the final decision | p. 80 |
Reviewing the decision | p. 81 |
Conclusions | p. 81 |
References | p. 82 |
Choice and best interests: symptom control and the maintenance of function | p. 85 |
The basis of most moral problems in symptom control | p. 85 |
Moral problems of symptom control in patients with capacity | p. 86 |
Moral problems of symptom control in patients who lack capacity | p. 90 |
Moral problems when the patient is imminently dying | p. 90 |
Moral problems when the patient is not imminently dying | p. 93 |
Conclusions | p. 96 |
References | p. 97 |
Choice and best interests: sedation to relieve otherwise intractable symptoms (terminal sedation) | p. 99 |
Identifying the problems | p. 99 |
What makes the analysis difficult | p. 100 |
Lack of a clear definition of 'terminal sedation' | p. 100 |
Lack of clarity about the fundamental moral concepts of intention, outcome and causality in decision-making about sedation | p. 102 |
Artificial hydration | p. 103 |
Clinical circumstances where there is consensus | p. 103 |
Clinical circumstances which are controversial | p. 105 |
Solution to the problems via the doctrine of double effect | p. 112 |
Solution via professional guidelines | p. 113 |
Anticipating loss of capacity | p. 114 |
Conclusions | p. 115 |
References | p. 115 |
Conclusions to Part 1 | p. 117 |
Introduction to Part 2: controversies | p. 119 |
Choice and advance care planning (ACP): definition, professional responsibilities | p. 121 |
National guidance on ACP | p. 124 |
Who should have the discussion with the patient? | p. 125 |
When should ACP be instigated? | p. 126 |
Information needed by patients for ACP regarding future treatment | p. 128 |
Professional responsibility for establishing validity and applicability | p. 130 |
Importance of recording and review | p. 134 |
Responsibility for taking advance statements into account in best interests judgements | p. 135 |
Ethically important common misunderstandings | p. 135 |
Failure to distinguish ACP from other forms of care planning | p. 136 |
Failure to recognize importance of voluntariness | p. 136 |
Failure to recognize the patient's right to confidentiality | p. 137 |
Failure to obtain the patient's permission to record the outcome of the ACP discussion | p. 138 |
Misunderstandings regarding the function of advance statements, advance care plans in best interests judgements | p. 138 |
Support for ACP, advance statements | p. 139 |
ACP: an intervention with a limited UK evidence base | p. 140 |
Cardiopulmonary resuscitation and ACP | p. 142 |
Conclusions | p. 143 |
References | p. 144 |
Preferred place of care and death | p. 147 |
The national context | p. 147 |
Ethical problems arising from the preferred place of care and death policy | p. 149 |
Voluntariness in ACP and care planning generally | p. 149 |
Pressure on patients to express achievable preferences | p. 150 |
Effects on decision-making for patients who lack capacity | p. 152 |
Audit | p. 153 |
The role of family members | p. 154 |
Use of resources | p. 156 |
ACP and preferred place of care and death: should we be asking a different question? | p. 162 |
Conclusions | p. 163 |
References | p. 163 |
Choice, assisted suicide and euthanasia | p. 165 |
The argument from 'moral equivalence' | p. 166 |
The argument from the 'right to die' | p. 169 |
A 'right to die'? | p. 170 |
Human rights and the 'right to die' | p. 173 |
The argument from dignity | p. 176 |
The analysis of dignity | p. 176 |
Dignity, assisted suicide and euthanasia | p. 178 |
A simple argument and a simple reply | p. 179 |
Conclusions | p. 181 |
References | p. 182 |
Best interests: extended senses | p. 185 |
'Best interests' extended to 'whole person' or 'holistic' care | p. 186 |
Meaning and dignity at the end of life | p. 195 |
Best interests and relatives | p. 198 |
The nature and extent of obligations to relatives | p. 200 |
Bereavement care: benefit or harm? | p. 202 |
Cost-effectiveness of benefit to relatives | p. 205 |
Conclusions | p. 206 |
References | p. 207 |
General conclusions | p. 211 |
Index | p. 215 |
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The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.