The Skill of End-of-Life Communication for Clinicians : Getting to the Root of the Ethical Dilemma

"With a focus on end-of-life discussion in aging and chronically ill populations, this book offers insight into the skill of communicating in complex and emotionally charged discussions. This text is written for all clinicians and professionals in the fields of healthcare and public health who are faced with questions of ethical deliberation when a patient's illness turns from chronic to terminal. This skill is required to manage care well in an age of advanced technology, and numerous autonomous choices. With a palliative care and ethics focus, the manuscript provides case studies illustrating issues which occur in the acuity and chronicity of end of life. Clear tools for clinicians, such as scripting and "the advance care planning video library" are included. The book focuses on the unique concept of outpatient ethics, including readmission prevention and shortened length of stay through good communication for clinicians who will be required to conduct this discussion with patients. The ethical undertone in this text provides a perfect opening for application in healthcare ethics classes, both in fields of public health and healthcare. Medical scholars and physicians, nurse practitioners and physician's assistants, as well as social workers, both in practice and training, will benefit from this text." -- Prové de l'editor Foreword by Kevin T. FitzGerald 7 Foreword by Ira Byock 9 Foreword by Renzo Pegoraro 10 Foreword by Christian Sinclair 11 Preface 12 Acknowledgments 15 Contents 16 1: Introduction to Daniel 17 Reference 24 2: Defining the Patient Population 25 2.1 Value-Based Concerns 27 2.2 Ethics and Communication 28 2.3 Results 30 2.4 Conclusions 32 References 34 3: Ethics and the Medicalization of Death 35 3.1 Principles of Healthcare 36 3.1.1 Autonomy and Paternalism...a Balance 36 3.1.2 Justice 38 3.1.3 Best Interest or Beneficence 39 3.1.4 Do No Harm 40 3.2 The Details in the Tools and Documents 41 3.2.1 The Truth About the Advance Directive 41 3.2.2 POLSTs and Other Documents 41 References 42 4: Ethics End-of-Life Cases 44 4.1 Case 1: Dean 45 4.2 Case 2: Abby 46 4.3 Case 3: Melvin 46 4.4 Case 4: Lila 48 4.5 Case 5: Ashley 48 4.6 Case 6: Henry 49 4.7 Case 7: Larry 51 4.8 Case 8: Sara 52 4.9 Case 9: Martin 53 4.10 Case 10: Michael 54 4.11 Case 11: Tom 55 4.12 Case 12: Rosa 56 4.13 Case 13: John (called Jack by family) 57 4.14 Case 14: Maria 59 4.15 Case 15: Randy 60 4.16 Case 16: Nina 61 4.17 Case 17: Evelyn 62 4.18 Case 18: Ben 63 4.19 Case 19: George 65 Reference 65 5: The Skills of Communicating Clearly 66 5.1 Clinical Skills and Communication 66 5.2 Developing Communication Skills 69 5.2.1 Basic Communication 69 5.2.2 Skill 1: Professional to Professional 70 5.2.2.1 Case Example 71 5.2.3 Skill 2: Starting the Conversation Early 72 5.2.3.1 Case Example 73 5.2.3.2 Case Example 74 5.2.3.3 Case Example 74 5.2.4 Skill 3: The Nut Graph of the Conversation 75 5.2.5 Skill 4: Compassion Is Learned 77 5.2.6 Skill 5: Owning the Discussion 79 5.2.7 Skill 6: Recognizing Cultural Barriers 80 5.2.7.1 Case Example 80 5.2.7.2 Case Example 81 5.2.7.3 Case Example 81 5.2.8 Skill 7: Defining Privacy Versus the Need to Be Informed 82 5.2.8.1 Case Example 82 5.2.8.2 Case Example 83 5.2.9 Skill 8: Steering Clear of False Hope 83 5.2.9.1 Case Example 84 5.2.9.2 Case Example 84 5.2.10 Skill 9: Recognizing Capacity 85 5.2.10.1 Case Example 85 5.2.10.2 Case Example 86 5.2.11 Skill 10: Bringing Together Everyone Who Matters 86 5.2.11.1 Case Example 87 5.2.11.2 Case Example 87 5.2.11.3 Case Example 88 5.2.12 Skill 11: A Note on the Faith-Based Population 89 5.2.12.1 Case Example 89 5.2.13 Skill 12: Learning the Logistics of Discharge 90 5.2.13.1 Case Example 90 5.2.13.2 Case Example 90 5.2.13.3 Case Example 91 5.2.13.4 Case Example 91 5.3 Conclusion 92 References 93 Epilogue 94 About the Author 96 Front Matter....Pages i-xxi Introduction to Daniel....Pages 1-8 Defining the Patient Population....Pages 9-18 Ethics and the Medicalization of Death....Pages 19-27 Ethics End-of-Life Cases....Pages 29-50 The Skills of Communicating Clearly....Pages 51-78 Back Matter....Pages 79-81