2010; Volume 11, No 3, March

Roger Woodruff, MD


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Palliative Care Books of the Month and other Book Reviews

Palliative Care Book of the Month

Against Physician Assissisted Suicide. A Palliative Care Perspective.

David Jeffrey

Radcliffe Publishing, 2009
120 pp
ISBN 978-184619-186-2
RRP $US29.95, £14.99
Review copy supplied by Elsevier Australia: www.elsevier.com.au

This is a clearly written review, concise but thorough, of the pros and cons of legalising physician-assisted suicide (PAS) in the UK viewed from the perspective of palliative care.  Jeffrey does an excellent job of presenting both sides of the argument, but fudging, double-talk and euphemisms are given their due. I hadn’t been aware of the significant recent increase in deaths associated with deep sedation in the Netherlands, possibly related to the fact that such deaths do not attract the same legal reporting requirements as deaths associated with euthanasia and PAS. Anybody who has an interest in the debate about PAS and euthanasia should read this book.

Roger Woodruff (Australia), an IAHPC Board Member
(February 2010)

Book reviews

The Case Of Terri Schiavo.
Ethics, Politics and Death in the Twenty-first Century

Kenneth W. Goodman (Ed)

Oxford University Press, 2010
ISBN 978-0-19-539908-0
RRP £30.00, $US45.00

Much has been written about the terrible story of Terri Schiavo, who in 1990 suffered a cardiac arrest that led to a persistent vegetative state, but was not allowed to die until March 2005.  In Goodman’s words ‘…when politics intervened, the Terri Schiavo story turned from tragedy to farce … a riot of kooky views and political vehemence.’

But this is a very serious book that sets out to dissect what we can learn about end-of-life care and decision making from this case.  The ten essays in this volume are written by a range of experts including ethicists, medical specialists and attorneys and cover the moral, ethical, medical, religious and legal aspects.  One can argue that there should not have been a political dimension.  The role of the media ‘to agitate and inflame public sentiment’ is rightly criticised in the final chapter. 

One little fact that I had not been aware of was that the Congress of the United States subpoenaed the permanently unconscious Ms. Schiavo to appear and testify.  Hmmm.


Mortally Wounded.
Stories of Soul Pain, Death and Healing

Michael Kearney

Spring Journal Books, 2007
157 pp
ISBN 978-1-882670-796
RRP $US19.95 £12.50

First published in the 1990s, and with a foreword by Dame Cicely Saunders, this is a collection of clinical stories about ‘soul pain’.  With a generous dose of Greek mythology, psychology, and image work, Kearney describes how we might go about enabling our terminally ill patients to find that inner peace.  I found this book enjoyable to read as well as challenging to consider.


Euthanasia And Law In Europe.

John Griffiths, Heleen Weyers and Maurice Adams

Hart Publishing, 2008
595 pp
ISBN 978-1-84113-700-1
RRP £60.00, $US126.00

Written by three academic lawyers from the Netherlands and Belgium, this book describes recent trends in the practice of euthanasia and physician-assisted suicide, the evolution of the associated law, and systems of control for these practices.  The prime focus is on the Netherlands, with a smaller section on Belgium, where legislation to legalise euthanasia was passed more recently.  The third section details what is known about practices in other European countries.  The book is detailed and well researched, if not light reading.

This is an excellent book that should be read by anybody with an interest in the debate about euthanasia and physician-assisted suicide, but the data presented does not ease my concerns about practices in the Netherlands.  They report a recent reduction in the number of patients treated by euthanasia without request and in the number of euthanasia cases overall.  But these seem to be balanced by a rise in deaths associated with ‘palliative’ sedation. (It was called ‘terminal’ sedation, but was changed to ‘palliative’ probably because it sounds nicer).  When last surveyed, Dutch doctors said they used ‘palliative’ sedation for the purpose of hastening the patient’s death in 50% of cases.  But, in classifying the types of deaths, we are told the Dutch have now moved past worrying about the doctor’s intention.  To me, there is a huge difference between giving sedation to a terminally ill patient and carefully titrating it to control clinical symptoms, and using larger doses with the intention of hastening/precipitating the patient’s death.  The Dutch need to provide data on patients dying with ‘palliative’ sedation—what drugs were used, what doses were given, and what the intentions were. That would be interesting, very interesting.  Could the fact that deaths occurring with ‘palliative’ sedation do not attract the same legal reporting requirements as deaths associated with euthanasia and physician-assisted suicide be relevant?

The other major theme in this book relates to the system of legal control. Griffiths, who is responsible for ‘a substantial research programme on the regulation of socially problematic medical behaviour (RSPMB)’, describes in some detail all the legal and legislative activity that has been designed to tighten the rules. As a physician, not literate in matters legal, I was left wondering whether they were really making headway or whether the Dutch had actually dug themselves a very deep hole. And legal rules need punitive teeth to be effective. When I last reviewed the results of Dutch trials regarding euthanasia/murder, I was amazed at the almost complete lack of punishment for those found guilty. Dr Van Oijen’s case (described on pp 40-41), involved a hearing by the Medical Inspectorate following which he was tried for murder (in the District Court, the Court of Appeals, and finally the Supreme Court) and found guilty, for which he was given a conditional fine of 5,000 guilders (about €2,250). 


Hospice And Palliative Care In Southeast Asia.
A Review of Developments and Challenges in Malaysia, Thailand and the Philippines

Michael Wright with Ednin Hamzah, Temsak Phumgrassami and Agnes Bausa-Claudio

Oxford University Press, 2009
219 pp
ISBN 978-0-19-957496-4
RRP £29.95 $US59.95

Following on from Hospice and Palliative Care in Africa, medical sociologist Michael Wright provides a review of the development of hospice and palliative care in Southeast Asia.  He provides detailed information about the state of palliative care in the three countries and there is also information about the health care system, reimbursement issues, opioid availability and consumption and much more.  Given that the barriers to developing palliative care in these countries, particularly in rural areas, is far greater than we faced in developed societies, one can only feel admiration.

Josefina Magno, who founded the organization that was to become IAHPC, is appropriately identified as one who helped kick-start palliative care in the Philippines.  I was one of those honoured to speak at the initial palliative care meeting organised by the Philippine Cancer Society in Manila, when palliative care was definitely in its infancy.  To read about what has happened since then is remarkable, although what remains to be done is daunting.  I think these books are a very useful source of information for palliative care planning at all levels and also serve to show how other people were able to overcome some of the barriers they faced. 


Mechanisms and Management Of Pain For The Physical Therapist.

Kathleen A. Sluka (Ed)

IASP Press, 2009
411 pp
ISBN 978-0-931092-77-0
RRP $US90.00 £95.99

There have been, I am told, major advances in the physical therapy for pain in the last 10-20 years, with empirical treatments being replaced by those that are evidenced-based.  This volume attempts to bring that body of evidence together in one place.  The initial section is about basic concepts and pain mechanisms.  The second is about physical therapy in pain management and includes discussions on exercise, nerve stimulation, other electrophysical and thermal agents, manual therapy, and more.  The third section is about interdisciplinary pain management and includes chapters on the medical and psychological management of pain.  The last section deals with selective pain syndromes, including myofascial pain, temporomandibular disorders, spinal pain, and the complex regional pain syndrome.  There is a reasonable use of tables and diagrams, and the text is well-referenced.  If you have a physical therapist or physiotherapist in your pain or palliative care team, you should tell them about this book.


Muddles, Puddles and Sunshine.
Your Activity Book to help when someone has died

Winston’s Wish.  Text by Diana Crossley, illustrated by Kate Sheppard

Hawthorn Press, 2009
32 pp
ISBN 978-1-903458-96-9
RRP £9.99 (One-third less of Amazon.co.uk ) $US13.57
Review copy supplied by Footprint Books www.footprint.com.au

Winston’s Wish is the leading childhood bereavement charity in the UK.  This well-thought out and colourfully illustrated book offers practical and sensitive support for bereaved children with a helpful series of activities and exercises accompanied by the friendly characters Bee and Bear.  It aims to help children make sense of their experience by reflecting on different aspects of their grief.  A child will need to find an adult to help them complete this activity book and there are Guidelines for Grown-ups inside the back cover.  If you hear of somebody struggling with a grieving child, think of recommending Muddles and Puddles.


Roger Woodruff (Australia), an IAHPC Board Member
(February 2010)

Dr. Woodruff is an IAHPC Board Member. For more information go to: http://www.hospicecare.com/Bio/r_woodruff.htm

View over 100+ IAHPC hospice & palliative care book reviews

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Note: Review copies become property of IAHPC and are not returned to the author. Only palliative care related books which are previously approved will be reviewed. Due to the large number of requests, we can't provide exact dates of when books will be reviewed.

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