In section three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In a final chapter, Dr. Quill discusses the tragic death of his brother which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives. Dr. Quill exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision-making, ensuring medical and palliative care expertise and of committing to see the dying process through to the patient's death is vividly illustrated. Nothing is harder than communication with patients and families at the end of life.
Nothing is more important to quality of care than effective communication.
Nothing is better for teaching than personal narratives. This book is fresh air for doctors who care for seriously ill patients. Dr. Quill brings the incredible privilege of being a doctor to life on the page. His book transcends the emotional pain and intimacy of accompanying our patients on their path, bringing a concise intellectual clarity and an organized approach to the complicated task of doctoring. In this book, he brings to bear all of his experience, his wisdom and his sensitivity, to help readers through this most difficult of journeys.