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Ideally the decision includes a discussion with the health care team, who can offer information about options and available support.

Palliative Care and End of Life Decisions | Medical Law Review | Oxford Academic

Several questions can help determine when palliative care becomes the main focus of care:. If someone has received all the treatments that might change the course of the underlying illness, then the next step is to focus on comfort.

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In this situation, the timing of palliative care is mostly determined by the illness and its treatment. Some people choose a comfort-focused approach right from the time of diagnosis of a progressive illness. For instance, someone may have several treatment options, such as surgery and chemotherapy , but after reviewing them carefully with the health care team decides against them.

Hospice or palliative care programs have criteria for their services. Typically someone who has less than six months left to live can be eligible. Someone with a prognosis of a few years can still choose a comfort-focused approach. In this situation, the timing of hospice care is mostly determined by the availability of palliative care services. Resources: Programs and Services. The path of a progressive illness, such as an incurable cancer, can often be anticipated.

At this point a person's condition appears to be declining steadily and the ability to function independently becomes a challenge. Setbacks or complications can happen throughout the illness and may be treatable and reversible. In early stages, palliative measures such as pain control may be only a small part of overall care. As the illness progresses, some previously reversible problems become irreversible, or the burden of treatment outweighs its benefits.

Then the focus of care turns increasingly toward comfort. For example, someone with lung disease may have had pneumonia previously, and had treatment in hospital to overcome the infection itself. With a palliative approach, symptoms such as shortness of breath are treated, while treatment for the pneumonia itself may or may not be given. The change of focus can come from the patient, or it can be determined by the illness.

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Increasingly, palliative care advocates promote a combined approach to care for patients with life-threatening illnesses. This means that palliative care provides comfort even while a disease is being treated. Advocates believe this approach helps people make more informed decisions about their care. The World Health Organization WHO defines palliative care as "applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life. In some areas, people can get palliative care from their health care team, and become part of a formal palliative care program near the end of life.

The criteria for palliative care services can vary. In this book he once again he jumps into the breach, reformulating the debate and setting out a way forward that will have a lasting impact on the field for years to come. Palliative Care and End-of-Life Decisions covers a broad range of issues, including the nature of pain and of pain management, the concept of medical futility, the doctrine of double effect, the regulation of physician-assisted death, and an analysis of the nature of a 'good death'.

Although dealing with a controversial issue, Smith does so with analytical depth and sophistication, while making an impassioned case for reform.

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