2020; Volume 21, No 10, October

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

Finding Dignity at the End of Life discusses the need for palliative care as a human right and explores a whole-person methodology for use in treatment. The point is made that there is a common thread among all individuals, despite all their innumerable differences, “that throughout disease there is a universal need to find purpose and peace as a component of comfort, alluding to treatment.” And the suitability and success of that treatment can be judged against five major levels of influence: intrapersonal, interpersonal, institutional, community, and public policy.

The first section of the book — Religion, Spirituality and Palliative Care — includes some remarkable observations and stories from Thailand and the Middle East, and from the perspectives of Judaism, Hinduism, Christianity, and what they term “nontraditional spirituality,” which includes a variety of groups from atheists to spiritual nones and includes nonreligious spirituality. Along the way, I read about Ringtved’s story for children Cry, Heart, but Never Break that I had not heard of before, but it appealed.

The second section — Palliative Care and Practice — includes discussions about palliative sedation, evidence-based communication in palliative care conversations, and ways of restoring dignity. I was pleased to see the widely-proclaimed woke concept that physician-assisted suicide (PAD) is necessary to ensure “dignity” is soundly refuted. The outstanding chapter is Dr. Christina Puchalski’s “Compassionate Presence—The Accompaniment of Patients and Families in the Midst of Their Suffering,” in which she describes problems and their origins, before putting forward suggestions of how we might learn to do better.

The last section — New Direction on Palliative Care — includes discussions of how PAD threatens the dignity of the vulnerable in Canada, how we might optimise pediatric and geriatric palliative care, and IAHPC Advocacy Officer Katherine Pettus, PhD, discusses the barriers to increasing the availability of palliative care, and what is needed both at a personal and political level. The concluding chapter, written by Pegoraro, asserts that modern medicine is losing sight of the sick person as a whole and is “neglecting what cannot be measured and treated: the soul of the person, his or her inner life, the fears and hopes of the patient, his or her relationship with family members and other significant people.” He advocates more emphasis on religions to help us to understand the meaning of the end of our lives and of our mortality. I would have preferred the term spirituality, as it is used elsewhere in this book, which includes every person’s innate spirituality that may be unassociated with any religious beliefs.

I was surprised by this book. It is both interesting and thought-provoking. It covers a lot of ground, from the shortcomings of palliative care (with an emphasis on spirituality and dignity), to how we might make it applicable to more people and make it more widely available. I would recommend this book to anyone who works in palliative care.

Kathleen Benton is a clinical ethicist who is president and CEO of Hospice Savannah, Inc. Renzo Pegoraro is a doctor, moral theologian, and bioethicist. He is chancellor of the Pontifical Academy for Life and Professor of Bioethics at the Faculty of Theology, University of Padua. The 27 contributors are drawn from around the world and give the book an international flavour.

(Roger Woodruff, September 2020)

Other Review

This is the companion volume to Perspectives on Behavioural Interventions in Palliative and End-of-Life Care, published in 2018 (see my review). The thesis for the present volume is that continued growth in palliative care, and end-of-life care in general, necessitates a renewed focus on behavioural and psychosocial issues. However, their definitions are broad, and “behavioural” includes psychological, social, spiritual, and ethical matters.

The first section of the book is about palliative and end-of-life care for specific populations. It includes chapters on living and dying well with HIV/AIDS, serious mental illness and palliative care, and person-centred end-of-life care for individuals living with dementia.

The second half of the book is about social and cultural contexts, including ethics, bereavement, and policy issues. The chapter on ethical issues emphasises problems related to decision-making capacity and family involvement, as well as the need for education (both professional and patient) when it comes to shared and informed decision-making. I thought the discussion of physician-assisted death and euthanasia was superficial and made no attempt to describe how most of the regulations described had been wilfully abused. There was an interesting discussion of what to do when patients autonomously choose not to be involved in their own end-of-life care. The chapter on diversity in family bereavement discusses innumerable different spiritual and ethnic groups. The chapter on the practice of psychosocial care and psychological interventions in palliative care programs underlines their importance to the patient and family, whilst noting that the psychological challenges and interventions are unique for each patient and family.

I thought this book provided a reasonable review, without anything startlingly new, of the psychosocial and psychological aspects of palliative and end-of-life care.

Rebecca Allen (PhD) is Professor of Psychology at the University of Alabama. Brian Carpenter (PhD) is Professor of Psychological & Brain Sciences at Washington University in St. Louis. Morgan Eichorst (PhD) is a clinical psychologist working within the Veterans Affairs organisation.

(Roger Woodruff, September 2020)

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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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