Palliative Care Book of the Month
TWELVE BREATHS A MINUTE
End-of-Life Essays
Lee Gutkind (Ed)
Southern Methodist University Press, 2011
267 pp
ISBN 978-0-87074-571-3
RRP $US23.95
Here is a collection of 23 essays about end-of-life care, very well written, encompassing many of the lows and highs of the medical care, personal relationships, and introspective reflections that accompany the dying process. Written by a range of players—doctors, daughters, mothers, a lawyer, sons, a 911 dispatcher, nurses, a hospice chaplain and a physiotherapist—it brings a broad view of the issues involved in good and bad end-of-life care, particularly for patients with non-malignant disease.
Sponsored by the Jewish Healthcare Foundation, which since its inception in 1991 has been involved in a number of innovations in the palliative care field, the aim of this volume was ‘to extend the community conversation [about end-of-life care] by allowing providers, patients, family members and others to express themselves and tell their stories.’ Mission accomplished.
The lay reader may find a lot of sadness and some depression in these stories, but conversation starters they certainly are. For people who work in palliative care, this book is a collection of refreshingly well-told stories on which to reflect. If you teach palliative care, this volume should be on your reading list.
Strongly recommended. I very much hope there will be a Volume 2.
**
DEBATING EUTHANASIA
Emily Jackson and John Keown
Hart Publishing, 2012
190 pp
ISBN 978-1-84946-178-8
RRP £15.00, $US30.00
Two heavyweights address the question of euthanasia, without knowing what the other has written. Emily Jackson is Professor of Law at the London School of Economics. Professor John Keown, who formerly taught law and the ethics of medicine in the Faculty of Law at Cambridge University, now holds the Rose F. Kennedy Chair in Christian Ethics in the Kennedy Institute of Ethics at Georgetown University.
The argument for change is made by Emily Jackson, who maintains that the case for status quo is indefensible, and I was left feeling she would know a number of ways in which I could be made a better person. She starts with a number of quotations from the emotional, highly-publicised cases, arguing that the law should be changed to accommodate the exceptional few; as a physician, I was led to believe that laws developed on exceptional cases were usually not good law. She argues against the various claims that change would be bad, but her recommended solutions are quite impractical. The need for a consistent request is self-evident, but the way she writes might lead you to think that doctor-patient interactions are black and white, clear-cut, and immune to all outside pressures on either party; the opposite is true. Her caveat that the patient is mentally competent is also self-evident, although how to establish this continues to worry the psychiatrists of Oregon and the UK. She advocates a social support ‘filter’ and a palliative care ‘filter’, but exactly how these would function is not defined. Given that no two patients present the same problems, it would be extraordinarily difficult and expensive to set up; from the clinical standpoint, it would verge on the impossible. I enjoyed reading her well-written and well-argued chapter, but nothing she said led me to think that a change in the law would be a good thing.
In return, John Keown (Euthanasia, Ethics and Public Policy, Cambridge University Press, 2002) quietly addresses the major reasons for changing the law – autonomy, legal hypocrisy, a right to suicide, compassion, and public opinion – and rebuts them all. Discussion of what is happening in the Netherlands and Oregon doesn’t lessen his argument. In particular, he notes that the apparent recent decrease in euthanasia in the Netherlands has been accompanied by a parallel increase in the use of terminal sedation, a procedure that does not involve the same regulatory and red-tape requirements as euthanasia. He goes on to dissect two of Emily Jackson’s recent papers and points out the fundamental flaws of the Joffe Bill.
A concise and excellent summary of the current state of play in the debate about assisted dying.
Roger Woodruff, MD (Australia)
Dr. Woodruff is a Lifetime Member of the IAHPC Board; his bio is at http://www.hospicecare.com/Bio/r_woodruff.htm
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