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Topics in Language Disorders:
doi: 10.1097/TLD.0b013e3182595b4d
End-of-Life Considerations in Clinical Practice

From the Editor: Introducing Topics on the End of Life

Section Editor(s): Nelson, Nickola Wolf PhD; Editor

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*Retrieved April 4, 2012, from

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

There is no cure for birth and death save to enjoy the interval.

George Santayana (1863–1952), American philosopher (Spanish born), in Soliloquies in England, 1922, “War Shrines”*

In this issue of Topics in Language Disorders, Issue Editors Mary Ann Toner and Barbara B. Shadden and their authors take readers on a fascinating and helpful tour through a topic that all of us will face in our personal lives and some of us will face in our professional lives—especially those who work with older adults. It is hard to imagine a topic of any greater significance to human beings than death. As Santayana implied in the aforementioned quotation, part of life's challenge is to make the most of living, including at life's end, living and communicating in the best manner possible.

It is the mission of this journal to provide information for researchers and practitioners interested in helping people with communication problems communicate more effectively in the authentic contexts of their lives. The end of life is not a context that has been addressed frequently in these pages, but it clearly is an authentic one.

Because it can be difficult to partition decisions about end-of-life care into neatly separated categories of speech, language, social communication, swallowing, and cognition, readers will find that the issue covers all those areas and raises questions about topics not frequently found in this journal on language disorders. These topics include an overview of issues relating to the end of life and processes of dying by Toner and Shadden (2012a). It also includes an article relating to swallowing (Groher & Groher, 2012), which can serve as a review for readers less familiar with this aspect of end-of-life decision making, with particular attention to ethical concerns, and an article by Lambert (2012) on how to support the decision-making process more generally. Another article addresses methods of communication at the end of life for individuals with amyotrophic lateral sclerosis (Brownlee & Bruening, 2012), informed by survey data on families' perceptions about maintaining communication during life's final weeks and days. Yet another article, by Pollens (2012), highlights aspects of the complex roles speech–language pathologists may play when swallowing, communication, and maintaining patient-centeredness and cultural sensitivity all require attention or must be prioritized.

I am delighted to introduce this issue to readers with the confidence that it will add to the literature on end-of-life issues in clinical care for adults. These articles, which are contributed by experienced clinicians and researchers from several disciplines (see the Issue Editor Foreword by Toner & Shadden, 2012b), offer information that can fill both personal and professional needs. It also is an aim of the journal to guide future investigations in topics in language disorders. In this case, the goal would be to find new ways to make communication as good as it can be during the last part of the interval between birth and death. Enjoy.

— Nickola Wolf Nelson, PhD


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Brownlee A., Bruening L. M. (2012). Methods of communication at end of life for the person with amyotrophic lateral sclerosis (ALS). Topics in Language Disorders, 32, 168–185.

Groher M. E., Groher T. P. (2012). When safe oral feeding is threatened: End-of-life options and decisions. Topics in Language Disorders, 32, 149–167.

Lambert H. (2012). The allied health professional's role in assisting medical decision making at the end of life. Topics in Language Disorders, 32, 119–136.

Pollens R. (2012). Integrating speech-language pathology services in palliative end-of-life care. Topics in Language Disorders, 32, 137–148.

Toner M. A., Shadden B. S. (2012a). End of life: An overview. Topics in Language Disorders, 32, 111–118.

Toner M. A., Shadden B. S. (2012b). Issue Editor Foreword: End-of-life care for adults—What speech–language pathologists should know. Topics in Language Disorders, 32, 107–110.

© 2012 Lippincott Williams & Wilkins