2019; Volume 20, No 8, August

IAHPC Book Reviews

By Dr. Roger Woodruff, IAHPC Reviews Editor

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

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

Palliative Care Book of the Month

This is the third volume of The Snowflake Chronicles published by Connor Court, dedicated to pushing the limits of political correctness. So-called progressive thinking limits free speech and limits the topics that may be discussed. They want to bring the discussion of topics like abortion and euthanasia back from extinction and allow contrarian views to be heard. Alleluia to that!

In the Foreword, Professor Patrick Parkinson explains that we live in an age of the individual, in which all constraints upon individual autonomy are challenged in the name of individual liberty and human rights. The demand for autonomy and the demand that you will not judge another’s choices or constrain their desires now extends into the euthanasia debate. The right is initially presented as an exceptional occurrence but over time, history tells us, it will apply to more and more individuals. This ‘normalization’ may occur because of more liberal interpretation of definitions in the legislation, medical practitioners prioritizing patients’ wishes, or the failure of the authorities to prosecute that renders the carefully crafted safeguards effectively redundant.

Kurti argues that the ‘right to die’ is a false right; it is merely a rhetorical device intended to halt any further discussion about the acceptability of self-inflicted death. He sets out to clarify both the power of the myth (the ‘right to die’) and how it threatens our culture. With no reference to any religious argument.

The book is structured as responses to ‘Seven Questions about Assisted Suicide.’ Among them, Kurti dissects the meaning of ‘death with dignity’, showing how a ‘right to refuse treatment’ has been twisted into a ‘right to die,’ and concludes that the phrase as used by proponents of assisted suicide has precious little meaning; he goes on to point out that neither a need nor a desire is identical to a right, but the use of rights rhetoric is more persuasive. When studied closely, the arguments about personal autonomy likewise have little meaning, and he notes that an appeal to autonomy in support of legalizing assisted suicide is inconsistent with the restrictions placed on its availability. And he details how legalizing assisted suicide poses threats to the social and cultural fabric of our society. I found his discussion of the ‘slippery slope’ from the historical/philosophical/moral perspective most interesting, but I did not think he paid enough attention to the clinical data that is available. His final question is about what impact legalized assisted suicide will have on the medical profession.

This excellent book and my booklet — Euthanasia and Assisted Suicide. Are They Clinically Necessary or Desirable?, available on the IAHPC website — are in many ways complementary. Kurti excels in dissecting the philosophical and moral aspects of arguments in favour of legalization, and what their catch phrases and slogans really mean (or do not mean), areas that I felt a little uncomfortable writing about. I simply collected the available clinical information, as reported, to show widespread abuse of regulations and the undeniable existence of a slippery slope in every jurisdiction where assisted suicide has been legalized.

The Premier of my home State of Victoria, Daniel Andrews, has been a keen advocate for legalized assisted suicide, which has now been enacted into law. Polls reported that 70% of the population were in favour of legalizing assisted dying, which was broadcast as 70% of the population wanting assisted dying. This is a lie: the data from Oregon show that only about 1.6% of patients dying of cancer (and who, I presume, voted in favour of the DWDA) chose assisted suicide; and two Canadian studies of terminal cancer patients receiving palliative care reported 63% to 73% in favour of legalization, but only 6% to 8% would request it if it were legal. We were told that legalization would eliminate all the suicides in persons who had ‘experienced an irreversible deterioration in physical health.’ This is rubbish: the data from the Netherlands and Oregon show the rates of non-assisted suicide have increased dramatically since the legalization of assisted suicide, and continue to rise. And we were told over and over again that under no circumstance whatsoever would anything but self-administered, oral medication be considered. But when the Victorian Bill was passed, it said that if the patient were unable to self-administer, or if there were any concerns about self-administration, then it would be fine for the doctor to administer an injection. What a surprise!

If you work in palliative care and have an interest in the assisted dying debate, I strongly recommend Kurti’s book. It is short, clearly written, and not overly clinical. As such, it may be something you could recommend to lay people interested in the issues, or perhaps your local legislators if they are considering legalizing assisted dying.

Peter Kurti is an ordained minister in the Anglican Church of Australia, a Senior Research Fellow at the Centre for Independent Studies, and Adjunct Associate Professor in the School of Law at the University of Notre Dame Australia.

(Roger Woodruff, July 2019)

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Other Reviews

This book is about caring for the dying from the perspective of the discipline of mental health, and the application of the quality care and practice of the palliative care approach within mental health practice. When palliative care is mentioned in everyday practice, there is a general assumption that the patient is dying, usually from cancer. So this book is yet another example of the principles and practices of palliative care have a major role in the treatment of patients with chronic diseases, not just those who are dying, and not just those with cancer.

This book is primarily about the application of palliative-care-type management in patients with mental health issues. There were interesting chapters on ethical issues, palliative psychiatry, cultural awareness, and human rights. The specific needs of children and adolescents, female adults, male adults, and older adults are dealt with in separate chapters. The management of patients with substance abuse (dependence syndrome), anorexia nervosa, and suicidal ideation are used to illustrate the principles described. There are other chapters that deal with end-of-life care in general, including discussions of sexuality and LGBTQ persons, and issues related to trauma and post-traumatic stress disorder.

This book is primarily directed at those who work in the field of mental health, but as I made my way through the book, I couldn’t help feeling it provided detailed insights into the management of mental health issues in end-of-life care generally. So if you work in ‘ordinary’ palliative care and have an interest in its mental health issues, this book will give you a lot to think about.

The structure of this book is excellent, with the liberal use of headings, bullet-point lists, diagrams, tables, case scenarios, and key points. There are numerous reflective exercises and self-assessment questions. Each chapter seems well referenced, and there are lists of where you might look to learn more about a particular topic. The contributors come from around the world, including the United Kingdom, North America, Ireland and Australia.

David Cooper comes from a nursing background and has worked in the field of mental health and substance abuse for many years. Jo Cooper is a retired Macmillan Clinical Nurse Specialist in Palliative Care, who edited the two-volume Stepping into Palliative Care (Radcliffe Publishing, 2006) that I thought were very good.

(Roger Woodruff, July 2019)

The goal of this book is ‘to provide both a broad and specific interdisciplinary, biopsychosocial, environmental, and life course perspective to understanding pain and palliative care.’

The book is divided into nine sections. The Introductory section covers the epidemiology of chronic pain and the biopsychosocial approach to understanding pain and disability. The second section is about pain and communication. The next is about pain assessment; I felt a little out of my depth when I came across the chapter regarding the estimation of pain in sheep using computer vision. The fourth has six chapters dealing with common pain conditions, and the fifth has eight chapters to do with pain mechanisms. The next section includes seven chapters on interventions and covers the whole range of treatment modalities, including the employment of virtual reality therapy and the use of digital therapeutics. The seventh covers the psychosocial, complementary/alternative (CAM), and spiritual care for pain. The next section discusses perspectives on pain from the humanities and social sciences. The last section covers ethical issues.

The material in this book seems comprehensive, is well presented and is referenced. If you or your service has significant numbers of patients with pain, particularly chronic pain, this book would be a useful resource and provide a lot for you to think about.

Rhonda Moore, PhD, is a data science anthropologist and social scientist with the U.S. Department of Health and Human Services. Of the 107 contributors, the majority are from the USA; of the rest, 10 are from the UK, four from elsewhere in Europe and two from Singapore.

(Roger Woodruff, July 2019)

This book is about the management of cancer pain in the setting of resource-poor countries, written by an international panel of pain physicians who mostly live and work in the developing world.

As far as attitude to cancer pain management is concerned, there are some good discussions about the need for comprehensive assessment and monitoring, and whether pain assessment should be the fifth vital sign. The benefits of psychological, interventional, and complementary therapies are described, and the need for multimodality pain management programs stressed.

There are several chapters dealing with the regulatory and educational barriers in the developing world. IAHPC Board Member Julia Downing contributed a chapter about overcoming the challenges of education about pain, and Executive Director Liliana De Lima has documented the fact that analgesics are more expensive for patients in low-income settings.

When it comes to the treatment of cancer pain, a range of topics are included, but it is a bit disjointed and does not present a smooth overview. In addition, the depth of coverage of the different topics varied greatly. For example, I thought the description of all the non-pharmacological therapies — physical, psychological, cognitive-behavioral, and mind-body therapies — was much too brief. And I wondered how widely available the complex surgical and interventional techniques described would be in the developing world.

If you are involved with treating cancer pain where resources are limited, this book will be of interest. It is focussed on the problems and solutions of managing cancer pain in the developing world. Whilst it may not provide a comprehensive overview, most of the issues are at least mentioned, and reading it will prompt you to think about how the way you treat cancer pain could or should be improved.

Professor Bhatnagar is Head of the Department of Onco-Anaesthesiology and Palliative Medicine at the All India Institute of Medical Sciences in New Delhi, India.

(Roger Woodruff, June 2019)

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Roger Woodruff, MD (Australia)
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.

NB: Review copies become the property of IAHPC and are not returned to the author. Only books related to palliative care that have been approved and have an ISBN will be reviewed. Due to the large number of requests, we cannot provide exact dates of when books will be reviewed.

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