IAHPC book reviews

2014; Volume 15, No 4, April

IAHPC book reviews

By Dr. Roger Woodruff

Palliative Care book of the month

Lack, Biller-Andorno & Brauer (Eds.)
Springer, 2014
213 pp
ISBN 978-94-007-7376-9
RRP € 99.99, USD 129.00, £ 90.00

The principles of advance directives are now widely accepted - to encourage and empower individuals to write advance directives for healthcare to direct and control treatment decisions in the event of future decisional incapacity - but until I picked up this volume, I was not aware of the complexity of the on-going discussions and arguments about their implementation and use.

The first section provides a history of advance directives and a summary of the arguments in favour (promoting a patient’s right to self-determination, limiting medical paternalism), as well as against. There are many problems encountered with interpretation and implementation of advance directives, both ethical and legal, most important of which is whether they are binding or not. In Austria it seems they can be regarded as advisory rather than binding, and there is the recently publicized situation in many states of the United States where if a woman is pregnant, her advance directive is ignored.

The second section deals with the scope and limits of advance directives as well as issues related to revocation. The third section deals with effects on family, friends and professional relations; the last develops an interesting argument that advance directives not only reduce medical paternalism but promote patient-centred care. The last section reviews the ethical challenges.

I found this book, with contributors from Europe, the United States and Great Britain, to be an interesting, informative, and readable review. As all the issues around the validity and implementation of advance directives evolve, I feel that people who work in palliative care have an obligation to be informed, both to promote patient autonomy and to spare some the pain and suffering and cost of futile therapy. This book will help you focus on the issues.

Other reviews

D. Yee-Melichar, C. Flores and E. Cabigao (Eds.)
Springer Publishing, 2013
368 pp
ISBN 978-0-8261-9567-8
RRP USD 90.00, £ 54.40

This book is about how we can best meet the needs of the rapidly increasing population of ageing boomers.

It is divided into three sections. The first describes the options - care at home, community-based services, assisted living communities and continuing care. Each chapter comes with a list of learning objectives, description of successful programs, a summary and references. The material discussed is primarily to do with management issues, but I was pleased to see that the patients’ needs and wishes were of primary concern.

The second focuses on current issues - improving quality of care and quality of life, and includes chapters on financial matters and litigation.

The third discusses trends in long-term care, including dealing with cultural and individual diversity and accommodating the spectrum of patients with Alzheimer’s disease. The last chapter was about ‘culture change’ in eldercare, a movement seeking to change the focus from a medically-centered approach to a person – centered / person - directed model. For one who has witnessed the evolution of palliative care for patients with advanced cancer, that sounded both familiar and good.

This book will be a useful resource for anyone headed for eldercare management and for those already there. In palliative care, we do not have to address matters related to the long duration of care, but there are some valuable pointers here as to how we might make palliative care more accessible to more people.

Wichmann M and Maddern G (Eds.)
Springer, 2014
304 pp
ISBN 978-3-642-53709-7
RRP € 119, £ 126.00, USD 189.00

Good general surgeons have always made themselves available to operate on patients with advanced or terminal disease where the goal is to improve the quality of the life remaining. Whether this is truly palliative surgery at the end of life or non-curative surgery performed earlier in the course of the disease, such surgery is important (particularly for the patient) and this book removes it from the miscellaneous bag and gives it the title Palliative Surgery and subjects it to the same scrutiny as some other branch of surgery in the hope of improving it.

The opening section deals with palliative care generally, including the psychosocial aspects, and concludes that the principles of palliative care are entirely appropriate for palliative surgery and underlines the need for multidisciplinary care (in this case, including the surgeon) in on-going management.

The second section deals with the special needs of patients having palliative surgery, including interactions with other treatment modalities (chemotherapy, radiation). There is a good chapter on image-guided interventions.

The last two-thirds of the book deals with palliative surgery by domain: the various parts of the gastrointestinal tract, the brain, the head and neck, the breast, etc. and the final three chapters summarize the role of palliative surgery in urology, gynecology and orthopedics. Where it is available the data, such as it is, is reviewed and there are some useful treatment algorithms.

This would be a useful book to have on the shelf in the palliative care unit, to guide junior staff as to what is possible and what the options are. It will not replace the need to have a surgeon sympathetic to palliative care in the multidisciplinary team. And it doesn’t solve the age old problem - that because something can be done means it should be done.

A Positive, Interdisciplinary Approach
JA Sugar, RJ Riekse, H Holstege & MA Faber
Springer Publishing, 2014
317 pp
ISBN 978-0-8261-0880-7
RRP USD 75.00, £ 64.50

Because many of the patients managed by palliative care services are older, I am always on the lookout for a brief but informative overview of gerontology that might be useful in broadening one’s horizons without requiring detailed study. This is not it.

This is written as an introductory text for college and university students. It is divided into six sections: Growing Older in the 21st Century, the Realities of Growing Older, the Diverse Living Conditions of Older People, Support Systems, Older People at Risk, and Public Policy Issues.

Each section is followed by a Practical Application. These are intended to show how the information in the main text can be applied in the real world, but I thought they were too brief to be useful; and they should be described as complementary, not complimentary.

The description of some of the medical matters left a lot to be desired. For example, osteopenia is not about the body resorbing bone cells, it’s about the amount of calcium in the acellular matrix; and providing a ‘boost to the immune system’ is not a physiological action of pyridoxine or selenium.

The section on euthanasia in The Netherlands startled me. Only good things are said and there is no mention of the thousand patients a year euthanized without request, euthanasia for treatable conditions like depression, the current surge in the use of terminal sedation (which doesn’t have to be reported and comes without the paperwork and risk of prosecution involved with euthanasia), etc., etc.

The 20-odd lines devoted to hospice care made me cross. I like to think that hospice and the principles of palliative care have contributed in the evolution of better care for our elders, but there is no mention here of any achievements at all during the last 30 years.

On reflection, this book may provide a general introduction to gerontology for students of psychology or sociology, but I would not recommend it to medical or nursing undergraduates, or to people coming into palliative care who wanted a broader view of gerontology.

Roger Woodruff, MD (Australia)
February 2013

Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.

Note for authors and publishers: If you wish to have your book reviewed, please send to:

Dr Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084

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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