A Palliative Ethic of Care: Clinical Wisdom at Life's End

In A Palliative Ethic of Care: Clinical Wisdom at Life's End, Joseph J. Fins, MD, has written a timely and sage book whose readership is likely to include the clinician, the legal practioner, as well as the lay person. Dr. Fins addresses the history of palliative care in careful, measured tones, and he writes well. The book's greatest asset may be its respect for its subject, the dying, and Dr. Fins gives all concerned parties equal voice in his sensitive, yet instructive text on life's final moments. This book should be on the required reading list for everyone who has to address a loved one's (as well as their own) death.

I'll admit it, I've become an oddity: a clinically informed lay person regarding end-of-life matters. I breezed through APEOC, nodding knowingly at most of the scientific disease-state terminology. The point is, you can too. For the specific symptom is not as important as the thought process Fins shares with readers. That this book is written for med students means it's also for lay people, because it's at heart a process guide.

The only way citizens can manage hospitalization and/or end-of-life matters is through information. Prognosis is but one type of information. Also crucial is understanding how the institutions we're bedded in function. According to what precepts and roadmaps. APEOC is a roadmap into provider thoughts when treating the obviously dying.

Being a writer and reader on these topics, my antennae are up, and I picked up a problem statement toward the end. Paraphrasing, in regards to unaccompanied patients with written directives and a study citing that those directives were (more) often ignored, Fins failed to say the next logical (and required) thing: "so, med students, don't you ignore ADs in these instances." I cite this oversight because it's important to realize that even docs who orient themselves toward more humane clinical practices miss pitches. This, of course, is why there's something called "patient advocacy".

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