The Dying Patient : The Medical Management of Incurable and Terminal Illness

The main purpose of this book is to bring together some description of the skills and attitudes of those working in the hospice units specializing in terminal care with those rather different but overlapping skills used daily in the palliation of chronic or incurable disease. This varied collection of papers does not pretend to be exhaustive. Among the omissions, for example, are two major causes of deat- chronic respiratory disease and stroke. This is because the treatment of the end-state of these conditions - and they are not alone in this - lies more in the gentle withdrawal of measures no longer appropriate rather than in any positive regime within the gift of the physician. This may lead on occasion to an unjustifiable diminution of interest, but this is less likely in cases of cardiac or malignant disease. Ischaemic heart disease remains the main killer of the western world. We may see important changes in our approach over the next decade as we document slowly and painstakingly the comparative ineffectiveness of our therapy; but in cases of progressive cardiac disease no matter how we may argue as to management or prevention, we are agreed that we must lighten the dreary burden of illness as effectively as possible. Front Matter....Pages i-xii The elderly at the end of life....Pages 1-15 The failing mind....Pages 17-44 Caring for children with cancer....Pages 45-55 Death, dying and the cardiac patient....Pages 57-79 Common problems in advancing chronic renal failure....Pages 81-110 Management of disseminated breast cancer....Pages 111-133 The patient with lung cancer....Pages 135-152 Palliation of malignant disease of the gastrointestinal tract....Pages 153-168 The management of refractory disease (myeloma, the lymphomas and gonadal tumours)....Pages 169-186 The control of pain I: by drugs; II: by non-drug methods....Pages 187-208 Management of other common symptoms of the terminally ill....Pages 209-231 The personal impact of dying....Pages 233-253 Therapeutic uses of truth....Pages 255-262 At home and in the ward: the establishment of a support team in an acute general hospital....Pages 263-288 The role of the specialist or hospice unit....Pages 289-310 Back Matter....Pages 311-336