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Palliative Care

Palliative Care
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  1600 John F. Kennedy Blvd.Ste 1800Philadelphia, PA 19103–2899PALLIATIVE CARE: CORE SKILLS AND CLINICAL COMPETENCIES ISBN: 978-1-4160-2597-9 Copyright # 2007 by Saunders, an imprint of Elsevier Inc.All rights reserved.  No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage andretrieval system, without permission in writing from the publisher.Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia,PA, USA: phone: ( þ 1) 215 239 3804, fax: ( þ 1) 215 239 3805, e-mail: may also complete your request on-line via the Elsevier homepage (, by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. Notice Knowledge and best practice in this field are constantly changing. As new research and experiencebroaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on proce-dures featured or (ii) by the manufacturer of each product to be administered, to verify the recom-mended dose or formula, the method and duration of administration, and contraindications. It isthe responsibility of the practitioner, relying on their own experience and knowledge of the patient,to make diagnoses, to determine dosages and the best treatment for each individual patient, andto take all appropriate safety precautions. To the fullest extent of the law, neither the Publishernor the Editors assumes any liability for any injury and/or damage to persons or property arisingout or related to any use of the material contained in this book.The Publisher Library of Congress Cataloging-in-Publication Data Palliative care : core skills and clinical competencies / [edited by] Linda Emanuel, S. Lawrence Librach. –1st ed.p. ; cm.ISBN 1-4160-2597-91. Palliative treatment. I. Emanuel, Linda L. II. Librach, S. Lawrence.[DNLM: 1. Palliative Care. 2. Clinical Competence. WB 310 P1661 2007]R726.8.P3427 2007616’.029–dc22 2006034475 Acquisitions Editor:  Kim Murphy  Developmental Editor:  Pamela Hetherington Project Manager:  Bryan Hayward Design Direction:  Lou ForgionePrinted in ChinaLast digit is the print number: 9 8 7 6 5 4 3 2 1  Dedication “The last stages of life should not be seen as defeat, but rather as life’s fulfillment. Itis not merely a time of negation but rather an opportunity for positive achieve-ment. One of the ways we can help our patients most is to learn to believe andto expect this.” Cicely Saunders, 1965 –First published in American Journal of Nursing;republished in   Cicely Saunders: selected writings  by David Clark Oxford University Press, 2006  We dedicate this book to the memory of Dame Cicely Saunders. In its pages,we have sought to provide for the core skills that a clinician needs in order to makeit possible for every man, woman and child that, when dying is necessary, itbecomes life’s fulfillment.Linda Emanuel, S. Lawrence Librach, 2007 Photo courtesy of St. Christopher’sHospice, London, UK  Contributors Carla S. Alexander, MD  Assistant Professor of Medicine, University of Maryland School of MedicineDirector of Palliative Care, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland HIV/AIDS   Wendy Gabrielle Anderson, MD Fellow in Palliative Care Medicine, University of Pittsburgh, Pittsburgh,Pennsylvania Withholding and Withdrawing Life-Sustaining Therapies  Peter Angelos, MD, PhD Professor of Surgery, Chief of Endocrine Surgery, Associate Director of the MacLean Center for Clinical Medical Ethics,Department of Surgery, University of Chicago, Chicago, Illinois Principles of Palliative Surgery  Robert M. Arnold, MD Professor of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaChief, Section of Palliative Care and Medical Ethics, University of Pittsburgh,Pittsburgh, Pennsylvania Withholding and Withdrawing Life-Sustaining Therapies   Al B. Benson III, MD Professor of Medicine, Associate Director for Clinical Investigations of theRHLCCC of Northwestern University, Department of Medicine,Northwestern University Feinberg School of Medicine, Chicago, Illinoisv
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