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Forgoing Life-Sustaining Therapy
How To Care For The Patient Who Is Near Death
By Margaret L. Campbell, RN, MSN, CS.
Ellen French, Editor
Foreword by Joanne Lynn, MD, MA, MS
Published by American Association Of Critical Care Nurses
Publication date: First Edition August, 1998
140 pp.
ISBN: 0945812779 (paperback)
Synopsis
Forgoing life-sustaining treatment can be one of the most difficult aspects of care for the dying. This concise and practical book is written for clinical care providers such as nurses and physicians. It gives sensible guidance on tough issues such as how to stop a ventilator, the use of artificial nutrition and hydration, forgoing dialysis, and management of delirium in the final days of life. Illuminating case examples draw out important clinical aspects of care while addressing ethical and legal considerations and the processes of communication and decision making.This authoritative medical resource dispels common myths about forgoing treatment, offers historical background on right-to-die cases, and provides definitions and discussions of ethical principles. We recommend it highly as a useful tool for hospice and palliative care workers. The book focuses on care in the hospital, but most of the issues also apply to care provided in settings such as residential hospices and home care arrangements.
Margaret L. Campbell, RN, MSN, CS, is a Clinical Nurse Specialist, Palliative Care. She has had extensive experience in hospital critical care settings and has directed the care of dying patients at Detroit Receiving Hospital since 1988. Much of what is included in this book is derived from the knowledge gained by caring for more than 1,700 patients in the final stages of life. Joanne Lynn, MD, MA, MS, is one of the world's leading authorities on end of life care.
Table of Contents
- Foreword
- Preface
- Acknowledgements
- 1. Ethical and Legal Considerations
- Normative Ethical Principles Related To Forgoing Therapy
- Ethical Issues Related To Forgoing Treatment
- Public Attitudes Regarding Life-Sustaining Treatment
- Life-Sustaining Treatment Decisions
- Reasons To Limit Treatment
- References
- 2. Communicating a Poor Prognosis and Making Decisions
- 3. Usual Care Requirements for the Patient Who Is Near Death
- Treatment Goals
- Benefit-Versus-Burden Model
- Ethical Concerns Regarding Palliative Care
- Terminal Sedation
- Pain Management
- Dsypnea
- Nausea and Vomiting
- Infection and Fever
- Edema and Pulmonary Edema
- Anxiety and Delirium
- Metabolic Derangements
- Skin Integrity
- Anemia and Hemmorrhage
- Care Settings
- Case Examples
- Summary
- References
- 4. Forgoing Mechanical Ventilation
- 5. Forgoing Dialysis
- 6. Forgoing Medically Provided Nutrition and Hydration
- 7. Responding to a Patient's Fear, Anxiety, and Delirium
- 8. Grief: Family Needs
- Index
Hospice and Home Care
Palliative Medicine
Withdrawing Treatment
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