Editors: Diane E. Meier, MD; Stephen L. Isaacs, JD; and Robert G. Hughes, PHD
ROBERT WOOD JOHNSON FOUNDATION SERIES ON HEALTH POLICY, 2010, JOSSEY-BASS, 452 PAGES, ISBN 978-0-470-52717-7
For a field as ancient as palliative care with one of the primary goals to “relieve human suffering,” the field has made the largest strides in the past two decades. Not because of any technological breakthrough, as might occur in cardiology or infectious disease, but rather because of a refocusing on the importance of shared medical decision making, patient and family rights, and investment in examining what happens when medicine can no longer cure.
The growth in intellectual capital in 20th century medicine rested primarily on two components of good medical practice: disease-centered diagnostics and therapeutics. But with the advent of each new technology the questions often followed about whether situations existed where the treatment should not be applied.
Because of the luxuries afforded by new diagnostic and therapeutic technologies, medicine faced some of the greatest ethical and moral challenges that could be effectively dealt with by only another component of good medical practice: communication. And with further understanding of the key role communication plays in medicine, palliative care has grown to become an accredited specialty. Yet, it wasn't always easy, and there is still a lot of work to be accomplished.
Palliative Care: Transforming the Care of Serious Illness is the newest release in the Robert Wood Johnson Foundation Series on Health Policy, which has successfully featured primary care, school health, and the impact of tobacco use. With this new addition to the series, editors Diane E. Meier, MD, Stephen L. Isaacs, JD, and Robert G. Hughes, PhD pull together the landmark articles in palliative care to give a comprehensive snapshot of the fantastic gains made in the last 20 years.
While the majority of articles come from the 2000s, the book does offer some historical perspectives on the changes from the previous decade as well.
As one would expect, the SUPPORT study from JAMA in 1995 is included, which is a must-read for any professional involved in health care administration, policy, primary care, palliative care, or hospice.
The other articles cover such diverse topics as intractable terminal suffering, curriculum development, access to palliative care consultations, the case of Terri Schiavo, and the (in)efficacy of living wills. Before each article the editors discuss the importance and context of the article to the field and to medicine in general. It would be nice to see this feature expanded in future books in this series as more discussion of these articles would be helpful.
The articles have more contextual exploration featured in the first chapter written exclusively for this book by Dr. Meier, Director of the Center to Advance Palliative Care and a 2008 MacArthur Foundation ‘Genius Grant’ recipient. Understanding the medical history and demographics of this modern life sets the foundation for why palliative care has risen to such a prominent position while being held at arm's length from the rest of medicine's curative approaches.
As someone who entered the field in 2003, Dr. Meier quickly frames the growth of the movement in a very clear manner for that chapter, information that I had previously been aware of but with punctuated gaps of knowledge. She was able to take me beyond a basic understanding of Saunders, leading to Kübler-Ross, followed by the SUPPORT study, on to Project on Death in America, and then to official specialty accreditation.
In addition, this chapter nicely summarizes many complex issues in the growth and sustainability for palliative care (and by extension, hospice) including: the availability of expert faculty to teach good palliative care, workforce issues, and policy hurdles, reimbursement challenges for a cognitive specialty, and legal implications such as physician-assisted dying.
‘The Fantastic Thing…’
The fantastic thing about discussing medical care for people with life-threatening illness is the ability to revel in the science and hard facts while simultaneously inquiring about the philosophical aspects of the human condition, which is done with great skill by Meier in the opening chapter as well as in the article selection overall.
Palliative Care is a field that naturally allows for reading Cassell's “The Nature of Suffering and the Goals of Medicine” right after reading a data-driven research article from, say, the Journal of the American Geriatric Society asking “Do Palliative Consultations Improve Patient Outcomes?”
The diversity in the types as well as the content of the articles in the book helps expand the audience that might find this book appealing, as opposed to focusing exclusively on policy, data-driven research. or broad inspirational essays with sharp insight.
While many of the articles chosen might be available through one's hospital or university library system, it would take some time to gather them all and you may not have easy access to some of the more historical and probably most important papers.
This book puts them all in one handy reference for any administrator, policy maker, or palliative care clinician/educator/researcher, and for that I am very appreciative.