Index:

This new edition of Julia Neuberger's little classic provides a wealth of information about the beliefs, customs and practices of the world's major religions, with particular regard to how these influence end-of-life care and what happens after the death.  There are also chapters on Chinese, Japanese and Afro-Caribbean beliefs and customs. This edition has a new chapter on Humanism.

Excellent.  Highly recommended.

The preface to this book states that 'physicians, patients and the public continue to harbor fears and misunderstandings about terminal illnesses and palliative care.  Many physicians continue to believe that "nothing can be done" for such patients because they are inexorably dying, and they remain ignorant of accepted principles and practices of palliative care.'  Well, here is a book to change all that, for neurologists at least.

After a brief introduction to the basic principles of palliative care, the book is divided into six main sections.  The first deals with the neurological disorders that lead to terminal illness, from stroke to motor neuron disease to muscular dystrophy.  Each chapter begins with an illustrative case history, provides a good overview of the disease process and treatment with particular attention to the palliative care management.  The second section (12 chapters) deals with the management of common symptoms in these patients.  The third deals with other problems associated with advanced disease and includes an excellent chapter on managing the dying patient.  The next section is particularly useful and covers the ethical issues that can cause so much difficulty in clinical practice: personal identity, food and hydration, sedation, advanced directives, refusal and withdrawal of treatment, physician-assisted suicide and euthanasia, and informed consent.  The final section deals with psychological, spiritual and cultural aspects of care.

The final chapter is very special.  It comprises the reflections of Dr. Ben-Joshua Jaffe as he became increasingly incapacitated with motor neuron disease.  His record is both moving and most insightful, and his discussion of the difference between acceptance and resignation is poignant. 

This book will be a valuable resource for neurologists, providing them with a wealth of information about symptom control, communication, end-of-life care and the ethical issues that accompany terminal illness.  It should be compulsory reading for all neurologists in training.  Although written for neurologists as part of OUP's Contemporary Neurology Series, I think this book would also be a very worthwhile addition to the palliative care library.  The editors are to be congratulated on a job well done.

My only concern is that the cost of this book will prevent it reaching the breadth of audience that it deserves.  It is a beautifully presented hardback volume with glossy paper, but similarly sized paperback texts from Oxford sell for one-third to one-half of the cost of this volume.  This book makes a strong case for other volumes about palliative care in other medical specialties, but I believe they should be produced in a manner that allows the widest possible readership.

How often in palliative care do you hear patients referred to as "a case of this" or "a case of that"?  This book serves as a timely reminder that palliative care must be able to respond appropriately to patients from a variety of social circumstances and communities and that each individual's treatment should be appropriate to their social context.  It underlines how important the social background is and presents discussions of what is appropriate end-of-life care related to poverty, social class, gender, sexuality, age, ethnicity and religion, as well as the circumstances of patients and carers who have disabilities, experience psychiatric illness, are refugees, are subject to abuse, or who are prisoners.  I found this book very thought-provoking and a timely reminder of the flexibility needed for truly holistic person-centered care.

What are the feelings and needs of families of patients dying on acute hospital wards?  Are they adequately managed?  How do staff nurses feel when dealing with the relatives of dying patients?  Do they avoid it, if possible?  Is it stressful?

This book is a detailed report of a research project designed to address these questions.  Phase 1 of the study set out to define the key issues from points of view of both the relatives and staff.  A two-day workshop was then held to discuss the findings and then to plan the development, implementation and evaluation of quality assurance standards for improved family support during terminal illness.  Post-intervention interviews with relatives and with staff document improvement and the liberal use of direct quotations from the interviews is a highlight.

This book would be a useful addition to the palliative care library shelf, particularly in acute hospitals.  It is a demonstration that change is possible and the clear documentation of all the processes involved make it a good example of how to go about quality assurance improvements.

Teaching palliative care is perhaps a little more difficult that other medical specialties because of the multidisciplinary nature of the topic as well as the learners.  This excellent little book provides just about all you need to know about planning, preparing, the different techniques of teaching, and evaluating palliative care teaching.  It is full of helpful hints and there are numerous useful checklists. Even experienced teachers will benefit from having this book available when next planning a lecture or a course.  I will.

Roger Woodruff
Medical Oncologist and Director of Palliative Care, Austin Health, Melbourne, Australia
November 2004