This book brings together clinicians, ethicists and lawyers to put the practice of continuous sedation under a critical spotlight.

The book’s main contribution is its interdisciplinary approach to the issue of sedation at the end-of-life. Because it occurs at the end of life, palliative sedation raises a number of important ethical and legal questions, including whether it is a covert form of euthanasia and for what purposes it may legally be used. Many of the book chapters address the first question and almost all deal with a specific form of the second: whether palliative sedation should be used for those experiencing “existential suffering”? This raises the question of what existential suffering is, a topic that is also discussed in the book. The different chapters address these issues from the perspectives of the relevant disciplines: Palliative Medicine, Bioethics, Law and Theology. Hence, helpful accounts of the clinical and historical background for this issue are provided and the importance of drawing accurate ethical and legal distinctions is stressed throughout the whole book. So the volume represents a valuable contribution to the emerging literature on this topic and should be helpful across a broad spectrum of readers: philosophers, theologians and physicians.

This new edition provides the essential clinical guidance both for those embarking upon a career in palliative medicine and for those already established in the field. A team of international experts here distil what every practitioner needs to know into a practical and reliable resource.

This volume provides a picture of palliative care ethics in the European context. It should interest those involved in the delivery and management of palliative care services, as well as students and researchers.

This textbook is the first to focus on comprehensive interdisciplinary care approaches aimed at enhancing the wellbeing of children with cancer and their families throughout the illness experience. Among the topics addressed are the epidemiology of pediatric cancer distress, including physical, emotional, social, and spiritual dimensions; the role of the interdisciplinary team; communication and advance care planning; symptom prevention and management; care at the end of life; family bereavement care; and approaches to ease clinician distress. The contributing authors are true experts and provide guidance based on the highest available level of evidence in the field. The book has not only an interdisciplinary but also an international perspective; it will appeal globally to all clinicians caring for children with cancer, including physicians, nurses, psychosocial clinicians, and chaplains, among others.

TERMINAL SEDATION DURING THE 1990s During the 1990s a discussion took place in scholarly journals concerning a measure within palliative care that had earlier attracted little attention, to wit, the sedation of dying patients. There seem to have been two main reasons why the practice came under debate. On the one hand, some people felt that, when palliative medicine had advanced and methods to control symptoms had improved, it was no longer justified to sedate the patients in a manner that had often been done in the past. The system of 1 terminal sedation had turned into ‘euthanasia in disguise’ or ‘slow euthanasia’. On the other hand, there were people sympathetic to the recently established Dutch system of euthanasia, people who agreed that terminal sedation was euthanasia in disguise, but who felt that, if it is not objectionable to sedate dying patients at their request, then why should it not be permitted for doctors to kill dying patients at 2 request? From these two motives a discussion about terminal sedation gained momentum. The intention behind this anthology is to continue and deepen this discussion. The anthology starts off with a chapter where an influential article from the 1990s has been reprinted.

This book analyzes the main topics of Palliative Care in Cardiac Intensive Care Units (CICU), from the changing epidemiology of patients admitted to the ICU, to the main clinical and ethical issues. The changing epidemiology of patients has led to new and emerging patient needs at the end of life. Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden, high mortality rate, and increased length of stay. The main new challenges involve shared decision-making, symptom control (pain, dyspnea, etc.), and ethical issues (withholding/withdrawing life sustaining treatments, deactivation of implanted cardiac devices, palliative sedation), all of which necessitate formal education on end-of-life care. Written by opinion leaders in their respective fields, who share their experience with improving the cultural and clinical competence of medical/nursing teams, this volume is chiefly intended for cardiologists, anesthesiologists, palliative care doctors and nursing staff.

From one of the world’s leading medical journals comes the definitive evidence-based, full-color guide to end-of-life and palliative care "...represents an important milestone in the evolution of care for people with advanced disease—-for which its editors and authors and JAMA should be rightly proud. It is wonderful that JAMA had the foresight to publish a series on this topic, which, as medicine has become more technologically advanced and subspecialized, is often overlooked and, sometimes worse, avoided....this book will be invaluable for front-line clinicians, and indeed all health care practitioners—as care at the close of life is a part of almost all of medicine’s specialties and settings."--Irene J. Higginson, BMBS, PhD, FPPHM, FRCP; Dept. of Palliative Care, Policy, & Rehabilitation; Cicely Saunders Institute; King's College London (from the foreword) A new addition to the JAMAevidence series, Care at the Close of Life: Evidence and Experience offers evidence-based and clinical expert guidance on caring for patients with life-limiting illness, incorporating the words and perspectives of affected patients, their families, and treating clinicians. Organized by these actual clinical cases, the book is based on the acclaimed 7-year series of 42 articles, originally published in JAMA as “Perspectives on Care at the Close of Life,” and now thoroughly updated as chapters and featuring extensive never-before-published material. Care at the Close of Life covers are a wide range of clinical syndromes, disease processes, communication challenges, health-care delivery settings, and issues faced by patients, including withdrawal of dialysis and other life-sustaining measures, cross-cultural approaches, and the role of chemotherapy. Throughout the book, emphasis is on the principles of palliative care, with the patient and family at the center of care, and with attention given to all problems—physical, psychological, social, and spiritual. Reflecting this focus, each chapter begins with a patient case study to introduce the clinical problem, followed by “perspectives” that draw on extensive, real-world dialogue between clinicians, patients, and families. Internationally renowned authors then review the typical challenges illustrated by the case, offering state-of-the-art, evidence-based assessment and treatment approaches. Features Fully revised and updated text with new evidence and references, including the search methodology for each chapter’s update Evidence-based orientation presents the current state of knowledge in the care of terminally ill patients and support for their families and caregivers Practical clinical guidance and approaches from international experts in palliative care Self-assessment Q&A, for reinforcing your knowledge of each chapter’s content and for preparing for exams A useful Glossary of acronyms, terms, and tests Updated Resources for each chapter offer current, authoritative sources of diagnostic and treatment information that can help you optimize palliative care Medline PubMed ID numbers facilitate quick, convenient access to references

In this book, James Dunson explores end-of-life ethics including physician-assisted suicide (PAS) and continuous sedation until death. He argues that ethical debates currently ignore the experience of the dying patient in an effort to focus on policy creation, and proposes that the dying experience should instead be prioritized and used to inform policy development. The author makes the case that PAS should be recognized as a legally and morally permissible option for a very particular kind of patient: terminally ill with fewer than six months to live and capable of conscious consent. Since focusing on the patient's experience of this end-of-life dilemma transforms some of the basic concepts we use to engage in the PAS debate, the argument has implications for patient care and the training of medical professionals.

This book discusses the common principles of morality and ethics derived from divinely endowed intuitive reason through the creation of al-fitr' a (nature) and human intellect (al-‘aql). Biomedical topics are presented and ethical issues related to topics such as genetic testing, assisted reproduction and organ transplantation are discussed. Whereas these natural sources are God’s special gifts to human beings, God’s revelation as given to the prophets is the supernatural source of divine guidance through which human communities have been guided at all times through history. The second part of the book concentrates on the objectives of Islamic religious practice – the maqa' sid – which include: Preservation of Faith, Preservation of Life, Preservation of Mind (intellect and reason), Preservation of Progeny (al-nasl) and Preservation of Property. Lastly, the third part of the book discusses selected topical issues, including abortion, assisted reproduction devices, genetics, organ transplantation, brain death and end-of-life aspects. For each topic, the current medical evidence is followed by a detailed discussion of the ethical issues involved.