Fast Facts
This Growth House feature presents the EPERC Fast Facts series in online web tutorial form. Developed in partnership with the End of Life Physician Education Resource Center (EPERC). Fast Facts is a collection of quick tutorials on common issues in palliative care. Intended for use by health care professionals, they can also be read with benefit by the general public. Issues covered include pain management, symptom management, tube feeding, withdrawl of treatment, and other important subjects.

The Primer Of Palliative Care
By Porter Storey. A concise and inexpensive overview of hospice and palliative care issues suitable for a general audience. This widely-used booklet is published by the American Academy Of Hospice And Palliative Medicine, an international professional organization for physicians involved with care for those who are dying and their loved ones. Includes material on nutrition in terminal care. Published July, 1994.

Oxford Textbook Of Palliative Medicine (Second Edition)
Edited by Derek Doyle, Geoffrey Hanke, and Neil MacDonald. The second edition of "the Bible of palliative care" is a comprehensive medical textbook and reference volume covering most practical aspects of hospice comfort care for the terminally ill. Covers quality of life assessment, pain and symptom management, pediatric issues, nutrition, psychiatric issues, special roles of members of the caregiving team such as nurses, occupational therapists, and social workers, plus many other topics. Now available in paperback. Published April, 1999.

European Association for Palliative Care (EAPC)
EAPC is a federation of national and regional palliative care organizations representing over 25,000 individuals across Europe. EAPC works to encourage information interchange in the areas of research, ethics, health policy, and education. Publications include the EAPC Journal, the EAPC Newsletter, and specialized items on palliative care, pain management, opiods, bowel obstruction, artificial hydration and nutrition, cancer, and other topics in several languages including English, German, French, Russian, and Italian. Their website includes links to related resources.

The American Academy Of Hospice And Palliative Medicine
An international membership organization of physicians dedicated to the advancement of hospice and palliative medicine in the care of the terminally ill. Web site includes information on events and meetings, certification in hospice and palliative care, and a link list. Offers a series of "UNIPAC" self-training modules for physicians who care for terminally ill patients and their families. The UNIPACs offer practical information and suggested interventions related to clinical situations, pain and symptom management, nutrition, ethical issues in withdrawing life-sustaining treatment, and legal matters in terminal care. The UNIPACs are approved for 3 credit hours of CME each. You can search the Growth House database from this site. AAHPM is a member of the Inter-Institutional Collaborating Network On End Of Life Care (IICN) which links major palliative care organizations internationally.

By No Extraordinary Means: The Choice to Forgo Life-Sustaining Food and Water
Joanne Lynn M.D., Editor. Intended for a professional palliative care audience, this book examines the medical ethics associated with nutritional care of the terminally ill and the difficult questions surrounding withdrawing life-sustaining treatment. The New England Journal of Medicine describes it as "...thoughtfully written ...well-edited, cohesively integrated... valuable for physicians, nurses, nutritionists, attorneys, members of the clergy... and the general public." Published 1990.

Forgoing Life-Sustaining Therapy
By Margaret L. Campbell, RN, MSN, CS. Foreword by Joanne Lynn MD, MA, MS. 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.

Nutritional Care Of The Terminally Ill
By Charlette R. Gallagher-Allred. A professional book for use by dieticians working in hospice and palliative care settings. Addresses needs, strategies, and ethics for feeding and palliative hydration. This is an update to the author's 1989 reference work on the same topic. Published January, 1997.

Nutritional Care Of The Terminally Ill
By Charlette R. Gallagher-Allred. A professional book for use by dieticians working in hospice and palliative care settings. Addresses needs, strategies, and ethics for feeding and palliative hydration. Published 1989.

American Society For Parenteral and Enteral Nutrition (ASPEN)
A professional membership organization for physicians, nurses, dieticians, pharmacists, and other allied health care professionals involved with the provision of clinical nutrition therapies. The organization works to ensure that every patient receives optimal nutritional care. Web site has information and links related to artificial feeding and hydration. An extensive line of publications include clinical practice guidelines, nutrition support clinical pathways, patient education resources, and two professional journals. Also offers an electronic mailing list.

Long Goodbye: The Deaths Of Nancy Cruzan
By Bill Colby. Author Bill Colby was the lawyer for the family of Nancy Cruzan, the only right-to-die case ever to come before the U.S. Supreme Court. Written with the drive of a novel, this absorbing memoir is a page-turner that lets us follow the Cruzan family during their agonizing struggle with removal of a feeding tube for their permanently-comatose daughter. Colby's clear narrative gives a no-nonsense introduction to troubling ethical questions of brain death, artificial nutrition and hydration, and medical interventions that can prolong physical existence long after the mind is gone. New paperback edition includes a discussion guide on advance care planning suitable for use in book clubs. Published 2002.

Washington Post: Life and Death Battle Plays Out In Virginia
A September 9, 1998, story on the difficult choices that familes face when confronted with persistent vegetative state situations. The story details the ethical dilemma faced by the Finn family of Virginia, which became embroiled in a legal battle over removal of father Hugh Finn's feeding tube. The story makes a strong case for documenting preferences for end of life care through the use of advance directives.

Tube Feeding Megasearch
This link performs an automated search for education materials related to tube feeding in the IICN Public Library, a repository of palliative care materials from several respected sources.

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