Since the publication of The Medical Care of Terminally Ill Patients in 1994, significant social and scientific progress has been achieved, in caring for dying patients. Society continues to address the issue of physician-assisted suicide and euthanasia with the passage of the Oregon Death with Dignity Act and the conviction of Dr. Jack Kevorkian for murder. Although these events may be viewed as a mixed message regarding societal values on assisting death, at the very least the issues are now being publicly aired. Therefore, chapter 13 (Issues Concerning the Sustaining of Life) has been expanded.
A review of the Oregon Death with Dignity Act experience reaches the somewhat surprising conclusion that the fear of intractable terminal pain is not a major factor in patients seeking physicianassisted suicide. Also, physician-assisted suicide and euthanasia, as practiced in the Netherlands, does not always result in a peaceful death. Clearly, the medical community has responded to the public pressure for better education of physicians in terminal care.
Numerous national initiatives, such as the American Medical Association’s Education for Physicians on End-of-Life Care and the American College of Physicians–American Society of Internal Medicine End-of-Life Care Consensus Panel have been undertaken to educate physicians on good care for their dying patients. Palliative care textbooks and new journals proliferate, and a few academic institutions offer palliative care fellowships.
Likewise, incremental scientific gains in caring for the dying patient have occurred over the past five years. To reflect this, over 100 new references have been added to this second edition and, as in the previous edition, I have attempted to include those papers that are scientifically sound and clinically applicable to the terminal care setting. Unlike cancer treatment palliative care has seen few randomized clinical trials; in some cases, especially the adjuvant analgesics (chapter 8, Adjuvant Analgesic Drugs), the information is often anecdotal and extrapolated from one chronic disease to another.
