Robert M. Arnold - Böcker

In few places in American society are adults so dependent on others as in nursing homes. Minimizing this dependency and promoting autonomy has become a major focus of policy and ethics in gerontology. Yet most of these discussions are divorced from the day-to-day reality of long-term care and are implicitly based on concepts of autonomy derived from acute medical care settings. Promoting autonomy in long-term care, however, is a complex task which requires close attention to everyday routines and a fundamental rethinking of the meaning of autonomy.This timely work is based on an observational study of two different types of settings which provide long-term care for the elderly. The authors offer a detailed description of the organizational patterns that erode autonomy of the elderly. Their observations lead to a substantial rethinking of what the concept of autonomy means in these settings. The book concludes with concrete suggestions on methods to increase the autonomy of elderly individuals in long-term care institutions.

This handbook explores the topic of death and dying from the late twentieth to the early twenty-first centuries, with particular emphasis on the United States. In this period, technology has radically changed medical practices and the way we die as structures of power have been reshaped by the rights claims of African Americans, women, gays, students, and, most relevant here, patients. Respecting patients' values has been recognized as the essential moral component of clinical decision-making. Technology's promise has been seen to have a dark side: it prolongs the dying process. For the first time in history, human beings have the ability control the timing of death. With this ability comes a responsibility that is awesome and inescapable. How we understand and manage this responsibility is the theme of this volume. The book comprises six sections. Section I examines how the law has helped shape clinical practice, emphasizing the roles of rights and patient autonomy. Section II focuses on specific clinical issues, including death and dying in children, continuous sedation as a way to relieve suffering at the end of life, and the problem of prognostication in patients who are thought to be dying. Section III considers psychosocial and cultural issues. Section IV discusses death and dying among various vulnerable populations such as the elderly and persons with disabilities. Section V deals with physician-assisted suicide and active euthanasia (lethal injection). Finally, Section VI looks at hospice and palliative care as a way to address the psychosocial and ethical problems of death and dying.

In the clinical setting, questions of medical ethics raise a host of perplexing problems, often complicated by conflicting perspectives and the need to make immediate decisions. In this volume, bioethicists and physicians provide a nuanced, in-depth approach to the difficult issues involved in bioethics consultation. Addressing the needs of researchers, clinicians, and other health professionals on the front lines of bioethics practice, the contributors focus primarily on practical concerns-whether ethics consultation is best done by individuals, teams, or committees; how an ethics consult service should be structured; the need for institutional support; and techniques and programs for educating and training staff-without neglecting more theoretical considerations, such as the importance of character or the viability of organizational ethics.

The Definition of Death: Contemporary Controversies is the first comprehensive review of the clinical, philosophical, and public policy implications of our effort to redefine the change in status from living person to corpse. It is the result of a collaboration among internationally recognized scholars from the fields of medicine, philosophy, social science, law, and religious studies. Throughout, the contributors struggle to reconcile inconsistencies and gaps in our traditional understanding of death and to respond to the public's concern that, in the determination of death under current policies, patients' interests may be compromised by the demand for organ retrieval.

When clinicians communicate effectively, patients retain more information, have higher trust and a better quality of life. Such a patient-centred approach is the future of clinical care, and this book is an essential how-to guide on improving these skills. Grounded in innovative and evidence-based methodology, perfected through over twenty years of teaching in the VitalTalk training program, content includes foundational communication skills, how to help patients plan for the future, what to do when you are really stuck, and strategies to work through conflicts with colleagues. In this updated edition, emphasis is placed on the roles privilege, race, and power play in the medical encounter, and new tools are provided to help clinicians navigate this landscape with greater self-awareness and sensitivity. This practical guide is filled with skills and roadmaps, demonstrating how to be clearer when sharing information, more competent at understanding patient concerns, and more effective when making recommendations.