bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction to the English Legal System 2018-19
Authors: Partington Martin
Published: August 2018

Introduction to the English Legal System 2018–2019 has been fully updated to consider the latest developments in the English legal system. The focus is on transformation. The criminal (Chapter 5), the administrative (Chapter 6), the family (Chapter 7), and the civil and commercial (Chapter 8) justice systems are all engaged in a process of change designed to enable them to operate more efficiently; this will include major investment in the use of IT in the delivery of court and tribunal services. Developments in the ways in which the legal profession is regulated are also discussed (Chapter 9), and the results of enquiries designed to control the cost of litigating are considered (Chapter 10). Progress with Brexit is noted, although its final form and its impact on the English legal system are not yet known (Chapter 3). The book starts by introducing themes and structure, after which Part II looks at law society and authority and considers the purpose and functions of law. Part III examines the institutional framework and looks into the role of government, the criminal justice system, the administrative justice system, the family justice system, and the civil and commercial justice systems; Part IV describes the delivery and funding of legal services; and Part V offers a reflection on the process of transformation and the challenges it should address.
1. Aims, themes, and structure
Authors: Partington Martin
Published: August 2018

This chapter presents the aims, themes, and structure of this book. The book provides an introductory account of the English legal system, how it has developed in recent years, and how it may develop in future. Part II raises fundamental issues about the social functions of law and the legitimacy of law; and considers the institutional framework within which law is made. Part III looks at the different context in which law is developed and practised. Part IV looks at the delivery and funding of legal services. Part V returns to the theme of transformation and the challenges to be faced.
3. Law-making: authority and process
Authors: Partington Martin
Published: August 2018

This chapter considers how law is made in the UK, who makes it, and the constitutional principles which give them the authority for making it and imposing it on society. There is a detailed account of the legislative procedure of the UK, and the different types of legislation that it enacts in Parliament. The role of the senior courts in the development of legal principle is also considered. Finally, the law-making functions of key institutions of the European Union are discussed, including the Council of Europe and the European courts. The impact of Brexit is also considered.
5. The criminal justice system
Authors: Partington Martin
Published: August 2018

This chapter focuses on the criminal justice system. It contains a summary of the different social theories that underpin the system as well as the fundamental principles relating to sentencing policy. The system is examined in three segments: pre-trial stages, trial stage, and post-trial stages. Each is discussed in turn. Particular emphasis is placed on how the current system is changing in the quest for improved efficiency.
6. The administrative justice system
Authors: Partington Martin
Published: August 2018

This chapter focuses on administrative justice. It reflects on the nature of administrative law and the role it plays in modern society. It discusses the courts, tribunals, ombudsmen, and other bodies and processes that make up the institutional framework of administrative justice. It also considers the responsibilities of Parliament in holding government to account. In addition, it asks who has general oversight of the system.
7. The family justice system
Authors: Partington Martin
Published: August 2018

This chapter discusses the family justice system. It considers the role law plays in regulating the family. It covers the institutional framework of family justice and its transformation; creation of the family court; the remedies available in that court; adoption; other matrimonial matters. It considers policy relating to child support, and notes changes to ways of dealing with domestic violence. It considers the legal practitioners involved in family law issues and changes to legal aid for funding for family law cases.
8. The civil and commercial justice systems
Authors: Partington Martin
Published: August 2018

This chapter discusses the civil and commercial justice systems. It considers the purpose of the civil justice system and also covers the use of alternative dispute resolution and the incentives to keep disputes out of the court. It looks at the court structure, the county court, the High Court, the newly created Business and Property Courts of England and Wales, and other courts and offices. It considers possible changes that may follow the transformation project. It also considers routes of appeal and the work of the appeal courts.
1. Introduction: US foreign policy—past, present, and future
Authors: Cox Michael , Stokes Doug
Published: August 2018

This work examines how domestic politics and culture shape US foreign policy, with particular emphasis on the role of institutions and processes. It considers the ways in which pressure groups and elites determine influence what the United States does abroad, the importance of regional shifts and media and their impact on the making of US foreign policy, and US relations with Europe, the Middle East, Russia, the Asia-Pacific region, Latin America, and Africa. The text also discusses key issues relevant to American foreign policy, such as global terrorism, the global environment, gender, and religion. It argues that whoever resides in the White House will continue to give the military a central role in the conduct of US foreign policy, and that whoever ‘runs’ American foreign policy will still have to deal with the same challenges both at home and abroad.
2. Theories of US foreign policy
Authors: Schmidt Brian
Published: August 2018

This chapter considers some of the competing theories that have been proposed to explain US foreign policy. It first provides an overview of some of the obstacles to constructing a theory of foreign policy before discussing some of the competing theories of US foreign policy, including systemic theories such as defensive realism and offensive realism, theories that accentuate domestic factors like liberalism and Marxism, and a theory that combines systemic and domestic factors, such as neoclassical realism and constructivism. The chapter also revisits the theoretical debate over the origins of the Cold War and concludes by analysing the debate on the most appropriate grand strategy that the United States should follow in the post-Cold War era, with particular emphasis on, primacy, liberal internationalism, and offshore balancing.
3. American exceptionalism
Authors: Deudney Daniel , Meiser Jeffrey W.
Published: August 2018

This chapter argues why we must think of the United States as an exceptional kind of nation with a very distinct past and an equally distinct set of capabilities. It first considers American difference and exceptionality before discussing the meaning of exceptionalism, the critics of American exceptionalism, and the roots of American success. It then examines the liberalism that makes the United States exceptional, along with peculiar American identity formations of ethnicity, religion, and ‘race’ and how they interact with — and often subvert — American liberalism. It also analyses the role of American exceptionality across the five major epochs of US foreign policy, from the nation’s founding to the present day. Along the way, the chapter explores notions of American liberal republicanism, anti-statism, state-building, militarism, capitalism and prosperity, immigration, federal internationalism, unipolarity, war on terrorism, and unilateralism.
11. Media and US foreign policy
Authors: Robinson Piers
Published: August 2018

This chapter examines the academic debates over the relationship between US public opinion, media, and foreign policy. It first considers the nature of US media and public opinion, including democratic expectations of mass media and public opinion, before discussing pluralist and elite approaches to understanding the links between media, public opinion, and foreign policy. It then explores the role of propaganda and persuasion with respect to US power projection, with particular emphasis on the ways in which public opinion and media can be understood as a source of power for — and as a constraint upon — US foreign policy. It also reviews contemporary debates regarding the impact of technological developments, such as the emergence of global media like the internet and social media, upon US power and influence.
12. US foreign policy in the Middle East
Authors: Dodge Toby
Published: August 2018

This chapter examines the main dynamics that have transformed US foreign policy towards the Middle East since World War I from the time of Woodrow Wilson to that of Donald Trump. It first considers the applicability of realist, Marxist, and constructivist theories of international relations before discussing the ways in which the Cold War, oil, and Israel have shaped American foreign policy. In particular, it shows how the United States’ tactical approach to the Middle East has increased resentment towards the Americans, destabilized the region, and undermined the USA’s long-term strategic goals. The chapter also explores the Bush Doctrine, launched after 9/11, the invasion of Iraq, and President Barack Obama’s attempts to deal with the Middle East during and after the Arab Spring. Finally, it asks whether the Trump administration’s policy toward the Middle East represents a radical change or a continuity with previous presidents.
15. US foreign policy in the Asia-Pacific
Authors: Zhang Feng
Published: August 2018

This chapter examines US foreign policy in the Asia-Pacific region. It first considers America’s rise as an major power and the introduction of the Open Door policy that became a major component of US policy during the period 1899–1941. It then shows how, with the conclusion of World War II, the United States achieved maritime hegemony in the Asia-Pacific and the historic policy of Open Door was rendered irrelevant by American preponderance. It also discusses the Korean War of 1950 and how it prompted the United States aggressively to apply the containment doctrine in Asia by establishing the so-called ‘hub-and-spokes’ bilateral alliance system; the outbreak of the Vietnam War; the Richard Nixon–Henry Kissinger opening to China in the early 1970s; and American foreign policy under Bill Clinton, George W. Bush, Barack Obama, and Donald Trump.
23. Drifting apart? The emerging end of the transatlantic partnership
Authors: Walt Stephen M.
Published: August 2018

This chapter examines the transatlantic partnership between Europe and the United States. It first considers US strategic interests and how they are now changing, along with the implications of this shift for US foreign and defence policy priorities. It then describes some of the fundamental challenges faced by the European Union, including over-expansion, the demise of the Warsaw Pact, the euro crisis, a deteriorating regional environment, the persistence of nationalism, and the refugee crisis. It argues that these challenges threaten the liberal order that is one of the West’s most salient achievements, raise serious questions about the EU’s long-term future, and make Europe a less reliable and valuable partner for the United States. The chapter concludes with an assessment of possible prospects for the US-Europe relations, including the (slim) possibility of a genuine renewal in transatlantic ties.
24. The future of US foreign policy
Authors: Lieven Anatol
Published: August 2018

This chapter considers future prospects for US foreign policy on the basis of long-established patterns and other factors such as the interests and ideology of elites, the structures of political life, the country’s real or perceived national interests, and the increasingly troubled domestic scene. It first examines the ideological roots of US foreign policy before discussing some of the major contemporary challenges for US foreign policy, including relations with China, US military power, and the US political order. It then describes the basic contours of US foreign policy over the next generation with respect to the Middle East, the Far East, Russia, Europe and the transatlantic relationship, climate change, and international trade. It also presents catastrophic scenarios for American foreign policy and argues that there will no fundamental change in US global strategy whichever of the two dominant political parties is in power.
25. US decline or primacy? A debate
Authors: Layne Christopher , Wohlforth William , Brooks Stephen G.
Published: August 2018

This chapter presents two opposing views on the question of whether US power is in decline, and if so, what would be the best grand strategy that the United States need to pursue. According to Christopher Layne, the United States is now in inexorable decline and that this process of decline has been hastened by the pursuit of global primacy in the post-Cold War era. He also contends that primacy engenders balancing by other great powers as well as eroding America’s ‘soft power’ global consensual leadership. On the other hand, William Wohlforth and Steven Brooks insist that the United States remains the sole superpower in the world and that it faces comparatively weak systemic constraints on the global exercise of its power. The chapter considers issues of unipolarity and multipolarity, along with the implications of China’s rise as a great power status for US foreign policy and hegemony.
5. Democracies, Democratization, and Authoritarian Regimes
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter examines democracy and democratization in relation to authoritarian regimes. It begins with a discussion of the three ‘waves’ of democratization that have occurred worldwide since the nineteenth century, the third of which began in 1974 with the demise of the long-standing authoritarian regime in Portugal, followed by the end of Franco's dictatorship in Spain in 1975. The chapter goes on to consider the main approaches to analysing democratization, different analytical models of democracy such as polyarchy and liberal democracy, and indexes to measure democracy. It also reviews the more recent literature on authoritarianism and the reasons for its persistence before concluding with an assessment of the challenges that confront democracy in the face of authoritarian revival.
9. Political Economy: National and Global Perspectives
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter examines the field of political economy from a historical, comparative, and international perspective, focusing on how ideas, practices, and institutions develop and interact over place and time. It first provides an overview of political economy as a field of study before discussing some important theories such as Marxism, liberalism, and economic nationalism. It then considers key issues such as the interaction of states and markets and the North–South divide, along with Karl Marx's critique of international political economy (IPE). It also explores the post-war international economic order and the twin phenomena of globalization and regionalization in the post-Cold War era before concluding with an analysis of the ‘boom and bust’ episodes in the global capitalist economy such as the global financial crisis of 2008.
10. Institutions and States
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter explores the relationship between the state and institutions and how political scientists theorize about them. It first provides an overview of the concept of institutions and the range of factors that structure political behaviour, noting how political, economic, and social factors determine particular outcomes, which are in turn influenced by ‘structure’ and ‘agency’. It then considers the multifaceted concept of the state and the rise of the European state, focusing in particular on the ways in which the European type of state and state system spread around the world between the seventeenth and twentieth centuries. The chapter goes on to discuss the modern state and some of the differences between strong states, weak states, and democratic states, suggesting that states need legitimacy and robust institutions to be strong.
15. Media and Politics
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter explores the link between media and politics. It first considers the more general relationship between the media and governmental organizations, and more specifically the overlap of governmental and media functions, and how dramatic representation influences our understanding of political life. It then examines the ways in which journalists and media organizations make news, along with the role of political journalism in political life, especially in democracies. It also discusses the globalization of media and the convergence of styles of news presentation and reporting on television around the world. Finally, it analyses the implications of the Internet and social media for political life, from potentially promoting democracy to accusations of false narratives and ‘fake’ news.
19. Conclusion: Politics in the Age of Globalization
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This concluding chapter summarizes some of the major themes and the threads of various arguments discussed throughout the book. It first emphasizes the complexity of the field and the ways in which political philosophy and the empirical study of politics are intertwined, arguing that the study of politics cannot be neatly separated from the study of other disciplines such as philosophy, law, economics, history, sociology, and psychology — and the fact that policy-making typically involves the natural sciences. The chapter proceeds by analysing how globalization influences political studies and highlights the limits of ‘methodological nationalism’ in political analysis. Finally, it considers Eurocentrism in the study of politics and contends that we cannot automatically assume the pre-eminence of Europe and the United States, or the West more generally, noting the apparent inevitability of the rise of other centres of power.
3. The Administrative Organization and Governance of Parliament
Authors: Petit Sarah , Yong Ben
Published: August 2018

This chapter discusses the administrative organization and governance of the UK Parliament — that is, the way in which the two Houses of Parliament are directed, managed, and led. More specifically, it deals with the administration or governance of services to Members of Parliament (MPs), and how that is organized. The discussion begins with an overview of the peculiar nature of Parliament as a public institution, highlighting five features which make governance and reform of governance difficult. The chapter then considers the basic structure of governance in the House of Commons and in the House of Lords, taking into account the statutory House of Commons Commission and the non-statutory House of Lords Commission, before describing contemporary developments in both Houses. It also looks at two future developments that may affect parliamentary governance and administration: the restoration and renewal of the Palace of Westminster, and the issue of shared parliamentary services.
6. Design and Space in Parliament
Authors: McCarthy-Cotter Leanne-Marie , Flinders Matthew , Healey Tom
Published: August 2018

This chapter discusses the role that design and space play in the UK Parliament. The architecture and design of parliamentary buildings and chambers occupy a central place in political culture. In the case of the Palace of Westminster, three elements must be highlighted: the external projection of the building, the internal structure and the manner in which it defines and dictates the use of space, and the manner in which the internal structures affect user-interactions in more subtle ways (for example, inspiring deference, augmenting partisanship, or perpetuating and preventing forms of democratic inequality). After explaining ‘how’ and ‘why’ design and space matter, the chapter traces the history of design and space in the Palace of Westminster as well as its building and rebuilding. It also considers attempts to change the design and architecture of Parliament and the difficulties of assessing design and space.
8. Parliamentary Scrutiny and Influence on Government Bills
Authors: Russell Meg , Gover Daniel
Published: August 2018

This chapter examines the political dynamics of legislative scrutiny, with an emphasis on how parliamentary policy influence works. A central function of legislatures is legislating. In the case of the UK Parliament, the treatment of legislation is one of the most time-consuming activities, with both Houses spending the great majority of that time scrutinizing government bills. The chapter first introduces the reader to common assumptions, including the idea that government dominates the process, with Parliament acting as little more than a ‘rubber stamp’, before questioning these various assumptions. It shows that non-government amendments may ‘fail’ but can nonetheless be influential, that government amendments do not necessarily imply government dominance, that the two Chambers often operate in cooperation rather than competition, and that parliamentary influence occurs throughout the policy process. Furthermore, the chapter suggests that the legislative process is less separate from other processes than it might appear.
10. EU Legislation
Authors: Beale Ed , Kurien Libby , Samson Eve
Published: August 2018

This chapter examines the ways in which the UK Parliament formally constrains the government and engages with European Union (EU) institutions. The House of Lords and the House of Commons both have processes to ensure that legislation proposed at the EU level has been properly reviewed before it takes effect in UK law. The ‘scrutiny reserve’, which stipulates that ministers should not agree to proposals under scrutiny, is used to elicit information about the government's negotiating position. Parliament also has a role in examining EU legislation and providing direct access to European institutions. The chapter first provides an overview of the EU legislative process, focusing on three principal EU institutions: member states, the European Parliament (EP), and the European Commission. It also considers the formal role of national parliaments in the EU legislative process, the UK Parliament's scrutiny of the EU legislation and its effectiveness, and parliamentary scrutiny after Brexit.
11. Campaigning to Change Law and Policy
Authors: Thomas Paul E. J. , Frier Stacey
Published: August 2018

This chapter considers the ways in which backbench Members of Parliament (MPs) and peers campaign to change laws and government policies. Policy and legislative campaigning is often conducted by groups of MPs and peers who work together across party lines. Such groupings are commonly supported by external pressure groups, who help to keep the parliamentarians informed on the issue, and who can also provide resources to support campaigning activities. MPs and peers also coordinate their parliamentary activities with lobbying by their pressure group partners. The chapter first examines traditional assumptions about influencing government before turning to actors involved in campaigning to change law and policy. It also describes the formal parliamentary tools as well as informal means employed by backbenchers who campaign for policy or legislative change, along with contemporary developments regarding such activity.
13. Small Parties and Law-making
Authors: Arnott Margaret , Kelly Richard
Published: August 2018

This chapter discusses the role of smaller parties in the law-making process. General elections in the UK are conducted with an electoral system which militates against the representation of smaller political parties, particularly those having no strong support at the regional level. However, events at Westminster over the last decade have increased the prominence of smaller parties in the operation of parliamentary business. The chapter first considers the role of small parties in the UK Parliament, committees and legislation, as well as their participation in backbench debates before examining how the political and electoral context of Parliament, especially in the twenty-first century, has affected the representation of smaller parties and the ways in which reforms to parliamentary procedure since the 1980s have enhanced the role of the second opposition party. It suggests that Parliament today offers more opportunities for smaller political parties to influence debate and policy, but this remains quite limited.
18. The Role of a Backbench MP
Authors: Shephard Mark , Caird Jack Simson
Published: August 2018

This chapter considers the nature and roles of backbench Members of Parliament (MPs) as well as their impact and influence, placing emphasis on the Backbench Business Committee. The term ‘backbench’ refers to where the MPs or peers sit in the House of Commons — behind those with either ministerial frontbench or shadow ministerial frontbench positions. The definition of a backbencher holds in many other parliamentary systems where the executive is drawn from the legislative branch (for example, Canada, New Zealand, and Australia). However, emphasis on the role of backbenchers might vary depending on the parliamentary system. The chapter discusses the role of backbenchers in the UK Parliament, such as supporting their party; scrutinizing government; representing and furthering the interests of their constituency and constituents; contributing to policy development; and promotion of public understanding.
20. Media Scrutiny of Parliament
Authors: D’Arcy Mark
Published: August 2018

This chapter examines media scrutiny of the UK Parliament. Major newspapers have always routinely featured Hansard-style reports of debates. Today, mainstream coverage of Parliament tends to focus on points of contention. Live coverage (mostly of the Commons Chamber) has become available on BBC Parliament, while the full array of Commons, Lords, Westminster Hall, and Moses Room sittings, plus committee hearings can be viewed on the much expanded Parliament TV online video service, both live and as archived recordings. This has implications for media reporting of proceedings and for the media's role in the way the public receives information about Parliament. The chapter first considers journalistic scrutiny of parliamentary proceedings before discussing the increasing role of new media in scrutinizing such proceedings as well as the role of the parliamentary media in explaining what is happening.
22. Women in the House of Commons
Authors: Campbell Rosie , Childs Sarah , Hunt Elizabeth
Published: August 2018

This chapter examines the progress of women's participation and representation in the House of Commons. It first considers women's descriptive representation in the House of Commons over the last century, with emphasis on the differences in the proportion of women Members of Parliament (MPs) elected by the main political parties. It explains improvements in the numbers of women MPs in the last decade or so, together with the party asymmetry, by reference to the supply and demand model of political recruitment. It then reviews arguments for women's equal participation in politics, taking into account how women's descriptive representation intersects with symbolic and substantive representation. It also discusses resistance to the claim that women's representation matters and concludes with an analysis of the masculinized nature of the political institution that women MPs inhabit, along with the recommendations made in the 2016 The Good Parliament report.
28. Parliament and Modernization
Authors: Goodwin Mark , Atkins Martyn
Published: August 2018

This chapter examines the path to modernization taken in the UK Parliament since 1997. Parliament has found it difficult to keep pace with changes in the wider society. As the key representative institution in the country, Parliament continues to hold on to many elements of the pre-democratic era. The chapter first considers the meaning of modernization before discussing the reforms sought by the Modernisation Committee, many of which concerned ownership and control of parliamentary time. It then analyzes the efforts of the Modernisation Committee to increase the effectiveness of parliamentary scrutiny and to address the representative function of Parliament. It also looks at the creation of the Wright Committee that replaced the Modernisation Committee, along with Parliament's technological modernization and modernization of the institution's working practices.
30. Parliament and Petitions
Authors: Caygill Thomas , Griffiths Anne-Marie
Published: August 2018

This chapter examines how the UK Parliament has used the e-petitions system to address some of the common criticisms about the relationship between the institution of government and the public. In May 2014, the House of Commons agreed to establish a ‘collaborative’ e-petitions system which would enable the public to petition the House of Commons and to call for action from the government. A Petitions Committee was created on 20 July 2015, and the new e-petitions site was launched the following day. The chapter first provides an overview of the changing nature of participation with Parliament, especially voting in elections, before discussing contemporary developments in petitioning Parliament. In particular, it considers public (paper) petitions and compares it to the e-petitions system. It also analyses the impact of e-petitions on Parliament and public participation and concludes with an assessment of challenges facing the e-petitions system.
31. Parliament and Freedom of Information
Authors: Worthy Ben
Published: August 2018

This chapter considers the impact of the Freedom of Information (FOI) Act 2000 on the UK Parliament. Since 2005, FOI 2000 has helped make both the House of Commons and the House of Lords more open and accountable. The most high-profile effect of the law came in 2009, when it played a part in exposing the abuse of the expense allowance system. Despite the scandal, it is not clear whether FOI has transformed the culture of the two Houses. Nevertheless, the law has indirectly sparked a series of other reforms, so that FOI now sits alongside a whole range of instruments intended to make Parliament more open and accessible. The chapter first provides an overview of what FOIs consist of, their application to legislatures and Westminster specifically, before analysing the extent of the impact of FOI 2000 on the UK Parliament.
Principles of Hospice and Palliative Medicine and Supportive Care
Authors: Yennurajalingam Sriram
Published: August 2018

The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” Hospice care, palliative care, and supportive care are the common terms used to describe the delivery of palliative care. They essentially require the same skill sets and are often delivered by the same group of health professionals. This chapter reviews the definition and core principles of hospice and palliative care.
Symptom Assessment
Authors: Guay Marvin Omar Delgado
Published: August 2018

Patients with advanced disease experience severe physical and psychological symptoms which are often underdiagnosed and often addressed only when severe and debilitating. Recent studies have shown that routine assessment of symptoms is significantly associated with improvement of quality of life and extending survival. The optimal delivery of quality palliative care involves improving quality of life by impeccable assessment of physical and psychosocial symptoms. Routine screening of symptoms using validated tools often results in thorough assessment of the significant symptoms and prompt and optimal management of symptom distress. This chapter reviews the key aspects involved in screening and assessment of symptoms.
Clinical Decision-Making in Palliative Care
Authors: Bruera Eduardo
Published: August 2018

Clinical decision making preference is defined as “an individual’s expectation of having the power to participate in decisions in order to obtain desirable consequences.” Understanding patients decisional control preferences is important as it improves patient-clinician communication, quality cancer care, patient satisfaction, and reduces cost of care. Palliative care decision-making differs from that of many other disease-oriented specialties. Palliative care clinical teams focus on personhood and family care rather than on disease management. Therefore, palliative care clinicians require a combination of disease, patient, and family information before decisions can be made. This chapter reviews various aspects essential for clinical decision-making in palliative care.
Principles of Assessment and Pain Management and Procedures in Pain Management
Authors: Loaiciga Francisco A. , Reddy Suresh
Published: August 2018

Pain has been a major concern in both inpatient and outpatient settings, particularly in patients with advanced diseases. In recent years, considerable progress has been made in the understanding of both acute and chronic pain mechanisms. The bio psychosocial experience of pain, whether it is a mixture or a single presentation of it’s different components, physical, psychological, social, or spiritual, may present a real challenge to both the patient and the treating team, and thus a clear understanding of it’s complexity, is of prime importance. Effective pain management involves an interdisciplinary approach using multimodal techniques, with the goal being to relieve the patient’s suffering. This chapter discusses basic concepts related to pain and its approach in routine palliative care practice.
Adjuvant Drugs in Pain Management
Authors: Eidelson David R. , Driver Larry C.
Published: August 2018

The etiology of cancer pain is often multifactorial, and management is therefore complex. Cancer pain often has both nociceptive and neuropathic pain features, as well as psychological symptoms modulating the expression of pain. Often, inflammation plays a central role in the pathobiology of chronic cancer pain. Therefore, in addition to use of opioids for the management of chronic moderate to severe cancer pain, it is important to consider adjuvants for effective pain management. This chapter discusses the key issues related to adjuvants such as anti-depressants (e.g., serotonin reuptake receptor antagonists, tricyclic antidepressants), α‎2-adrenergic receptor agonists, anti-epileptic, and anti-inflammatory agents for pain management, including indications and side effects.
Anorexia–Cachexia Syndrome and Hydration
Authors: Del Fabbro Egidio G.
Published: August 2018

Cachexia is a complex multiorgan syndrome involving multiple biological mechanisms and found in many seemingly disparate diseases. Cachexia is characterized by weight loss and unresponsiveness to nutritional support alone. It is caused by both primary and secondary factors. Primary cachexia is a result of disease–host interactions causing alterations in pro-inflammatory and neuroendocrine factors. These lead to inflammatory and metabolic changes, including increased systemic inflammation, acute phase response, proteolysis, lipolysis, and resting energy expenditure and decreased protein synthesis, lipogenesis, and appetite. Secondary causes of cachexia exacerbate poor appetite and decrease food intake. These secondary causes include pain, nausea, taste alteration, depression, comorbidities, and gastrointestinal obstruction by the tumor. No single pharmacological treatment is consistently effective for cachexia. Megestrol and corticosteroids improve appetite and weight, not lean body mass. Cannabinoids and growth hormone benefit patients with HIV, and ghrelin and ghrelin mimetics have recently demonstrated efficacy in cancer cachexia.
Management of Psychological Symptoms Including Anxiety and Depression
Authors: Guay Marvin Omar Delgado
Published: August 2018

Most advanced cancer patients develop psychological symptoms, either alone or in combination with physical symptoms. Frequently psychological symptoms complicate management of physical symptoms such as pain. Routine screening is essential for diagnosis. Among the many possible psychological symptoms, the most common are adjustment disorders, anxiety disorders, depressive disorders, and cognitive disorders, which can be major sources of distress for patients and can pose significant management problems. Treatment may include combination of psychotherapy as well as pharmacotherapy. In this chapter we will review the diagnosis, and management of the most common psychological symptoms such as anxiety and depression experienced by the patients receiving palliative care.
Other Symptoms
Authors: Walker Paul W.
Published: August 2018

In the Palliative Care setting, patients with advanced cancer and limited life expectancy frequently experience poorly controlled physical and psychological symptoms. Symptoms such as pain, nausea and shortness of breath, are readily assessed and treated. However, there are many other prevalent symptoms that often remain unaddressed in clinical practice which is the source of significant distress to patients receiving palliative care. Xerostomia, hiccups, pruritus, pressure ulcers, malignant wounds, lymphedema, and myoclonus are more common in patients receiving palliative care. These are usually due to the advanced disease, treatment, and declining health status. This chapter reviews the diagnosis and management of these symptoms.
Cultural Issues in Palliative Care
Authors: Yennurajalingam Sriram
Published: August 2018

Culture play a significant role in the care of patients receiving Palliative care. Understanding and managing cultural differences in end-of-life care is important as misunderstanding can result in under-treatment and unnecessary suffering for the patient and their care providers. Therefore better understanding can improve patient–physician communication and potentially improve patients’ quality of life, coping, and facilitate patients to make informed decisions and set appropriate priorities with regard to treatment and end-of-life care. This chapter discusses key cultural issues in palliative care, including the concepts of nondisclosure, the importance of the use of a medical interpreter, and the importance of an interdisciplinary team.
Palliative Care in the Last Hours of Life
Authors: Azhar Ahsan
Published: August 2018

Patients with life-limiting illnesses often experience severe distressing psychosocial and physical symptoms during the last hours of life. Prompt relief of suffering is paramount; hence, accurate assessment and effective management of symptoms, along with excellent communication skills, help clinicians not only relieve patients’ distressing symptoms but also provide education about end of life along with psychosocial and emotional support to the caregivers. The aim is for improving the quality of life of patients and caregivers and reduce the incidence of complicated grief especially among the over-whelmed caregivers. This chapter reviews the key aspects of care of patients in the last hours of life.
Communication and Teamwork
Authors: Bruera Eduardo
Published: August 2018

Palliative care addresses physical, psychosocial, and spiritual dimensions of patients and their families. The care is focused on the person rather than on the disease. Therefore, the expertise of various health care professionals including physicians, advanced practice providers, nurses, social workers, chaplains, pharmacist, physical therapists and others are necessary to manage these patients’ complex needs. For the provision of optimal coordinated care excellent communication is integral part of this interdisciplinary approach. To facilitate such communication routine interdisciplinary clinical case discussion and meetings with essential team members should occur. In this chapter, the need for interdisciplinary teams in palliative care, team composition, communication, and leadership for interdisciplinary teams are outlined.
Family Conference in Palliative Care
Authors: Isaac Margaret L. , Curtis J. Randall
Published: August 2018

Patients receiving palliative care often experience severe psychosocial distress, which may due to the perception of the situation, the community resources and support, educational level, comorbidities, coping skills, and socioeconomic status. However, the distress can be reduced by communication between patients, caregivers, and health care providers. Studies have shown that family conferences can be a safe and well-accepted means for communication between patients, caregivers, and health care providers in the palliative care setting. This chapter highlights key topics regarding the family conference and facilitation of patient–clinician communication in palliative care. The topics covered in this chapter include (a) key components of a family conference (e.g., the importance of listening, therapeutic communication, and missed opportunities), (b) proactive communication strategies in the intensive care unit, (c) use of patient navigators and communication facilitators to reduce family distress, and (d) the impact of advance care planning on end-of-life decision-making regarding resuscitation.
Ethical and Legal Decision-Making
Authors: Zhukovsky Donna S. , Gallagher Colleen M. , Baker Francis
Published: August 2018

Ethical and legal decision-making are integral components of palliative medicine. The four key principles of Western bioethics are autonomy, nonmaleficence, beneficence, and justice. In routine palliative care practice, withdrawing unwanted treatment is consistent with the principles of bioethics. Also, physician’s intent is the key to the doctrine of double effect as physicians administer treatments such as opioids for pain. This chapter highlights key topics addressing issues related to ethical and legal decision-making in palliative care including use of surrogates for decision-making, requests for assisted death, informed consent, and privacy concerns. The chapter also considers clinical concerns such as resuscitation status, nutrition and hydration, communication and culture.
Prognosis
Authors: Rossi Romina , Scarpi Emanuela , Maltoni Marco
Published: August 2018

Prognostication of life expectancy is one of the three main components of medical intervention, along with diagnosis and therapy. The prediction of survival is important for clinicians to decide the goal of care, for patients and families to prepare for the time ahead, and for both to obtain good and honest communication and share decision-making. This chapter presents different tools of prognostication during the trajectory of a serious chronic illness, particularly cancer. An accurate prognostication may lead to different care planning and care settings. Prognosis is an important referral criteria for palliative care. During the past few years, several prognostic factors have been used and some prognostic scores have been developed, but these are still underused in clinical practice. Finally, further research is required to improve the accuracy of prognostication of life expectancy in patients with serious chronic illnesses.
Palliative Care in End-Stage Chronic Obstructive Pulmonary Disease
Authors: Nguyen Linh My Thi
Published: August 2018

Patients with end-stage chronic obstructive pulmonary disease (COPD) experience high symptom burden due to severe dyspnea, fatigue, anxiety, depression, disability, and social isolation, resulting in poor quality of life. The caregiving burden for the family is also severe. Despite high symptom burden, because of limited access and difficulty with prognostication, the quality of care for patients with end-stage COPD who receive palliative care compares poorly to the care received by patients with cancer, and the proportion of COPD patients who receive palliative care is much lower than that of cancer patients. Therefore, patients with COPD receive less palliative care and die following more aggressive treatments at the end of life compared to patients with lung cancer, despite having the same preferences for palliative care. This chapter discusses the key issues related to end-stage COPD, including symptom assessment, management, and hospice eligibility.
Palliative Care in End-Stage Liver Disease
Authors: Nguyen Linh My Thi
Published: August 2018

End-stage liver disease (ESLD) is the final result of various pathophysiological disturbances that underlie chronic liver diseases. ESLD is associated with significant physical and emotional distress as a result of known complication such as ascites, spontaneous bacterial peritonitis, electrolyte abnormalities, hepatic encephalopathy (also known as portosytemic encephalopathy), esophageal varices, pruritus, hepatorenal syndrome, and hepatocellular cancer. This chapter discusses the key issues related to ESLD, including pain (opioid and non-opioid pharmacological management), symptom management (e.g., cholestatic pruritus, hepatic encephalopathy), and prognosis. Drug selection and dosing is based upon the severity of liver disease (compensated vs. decompensated cirrhosis) and if there is coexisting renal failure. Decompensated cirrhosis is characterized by the presence of dramatic and life-threatening complications such as variceal hemorrhage, ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy. Prognosis is highly variable, and once decompensation occurs, mortality rates are high. The Child-Pugh classification and MELD are two commonly used predictive models.
Palliative Care in End-Stage Renal Disease
Authors: Nguyen Linh My Thi
Published: August 2018

Patients with end-stage renal disease (ESRD) often experience a multitude of physical and psychosocial symptoms. The life expectancy of patients on dialysis is approximately 20% of that of age-matched individuals without renal disease. Of note, uremic calciphylaxis (or calcific uremic arteriopathy) can cause painful skin lesions and portends a poor prognosis. Frequent assessments, early intervention, and involvement of the interdisciplinary team are key to providing care for these patients. Decision-making for the initiation and withdrawal of dialysis is a complicated process. The prognosis after withdrawal of dialysis is usually short, and symptoms associated with uremia such as seizures and nausea should be treated promptly. This chapter discusses the key issues related to ESRD, including symptom management and end-of-life discussion.