By Jeffrey David , Radcliffe Publishing Ltd; , 2005. . PB £21.95 , 171 pp . ISBN 1 85775 621 5
Patients are in a vulnerable position at the end of their life, as are those close to them and the health‐care professionals caring for them. It is a difficult time during which communication can easily break down, misunderstandings arise and anger and resentment develop. This text endeavours to address some of the complexities of end‐of‐life care and sets out to bridge some of the misunderstandings between patients and their carers. Jeffrey aims at giving professionals involved in the care of the terminally ill the confidence to involve patients in decision making and to facilitate communication. However, the book moves beyond this aim and actively encourages the bridging of misunderstandings between professionals. The approach advocated is very much a team one imbued with respect for all others involved in the care of the patient. The central theme is of communication between all parties and it is only through communication that not only the patient, but the health‐care professionals as well, can obtain the care and support needed.
The author aims at improving understanding of the reasons for the all too common communications breakdown experienced in palliative care settings. He suggests that communication with colleagues and patients can be improved by understanding why it breaks down. Such a position could be viewed as an oversimplification of the problems experienced in this context, but I believe it is a strong position and enables the book to explore the many facets of, and obstacles to, effective communication. This helps the reader to gain some insight into the complexities of the relationship between the health professional, the patient and their loved ones. These relationships themselves are sometimes subject to oversimplification, but here we are encouraged to recognize their many and complex layers.
The book is clearly written and moves neatly from an exploration of ideas and ideals in part 1 (Ethics, communication and palliative care), through a consideration of the practical dilemmas surrounding death and dying in part 2 (Death, dying and dilemmas) to the provision of practical advice in part 3 (Good practice). I particularly liked the structure of part 2 which addresses the dilemmas through a series of questions often raised by patients. These questions are discussed and suggested solutions offered. Significantly, each solution is centred on the core principle of improved communication.
One of the strengths of this text is that it positions the patient as the central focus of a group of people, recognizing that the patient is not an individual isolated from the world and all those around them. The patient's needs as a member of a broader group are recognized and it is repeatedly emphasized that caring for the patient entails so much more than simply treating the symptoms of their disease.
The changing needs of the patient are recognized and this is well illustrated in the position that one cannot approach ethics from a purely principalistic position – it is not only about ideological principles, it is about practical realities and dilemmas that confront health‐care professionals and all involved in palliative care on a daily basis.
In endeavouring to improve the standard of care of patients, the question of ethics is moved from its philosophical pedestal and placed squarely in the centre of clinical activities. In approaching ethics from a practical position Jeffrey encourages a shift from the medicalization of death towards a respectful, realistic and supportive palliative care team, focused on the core principle of palliative care: a good death.
The style of the work is accessible and clear. Each chapter includes scenarios which support and explain the more theoretical discussion, providing practical examples of his main themes. At the end of each chapter there is a summary of the key points which help to focus the reader's mind on what the author views as the core ideas.
The book is perhaps a little ambitious at times, as it attempts to cover a broad spectrum. However, it would be inconsistent if the book had overlooked a consideration of the different ethical theories. This exposes the reader to some complex theories in a simple and clear manner.
This is, overall, a readable book in which communication and ethics take a central position. Whilst brief and at times lacking in deep analysis and discussion, the book provides an excellent introduction to some of the underlying problems facing those involved in palliative care work. It introduces some vital concepts and interesting ideas, all of which can be further researched elsewhere. The book would be of benefit to anyone involved in palliative care including patients, their support network of family and friends and the palliative care team.