Intimations of Mortality
Medical Decision-Making at the End of Life

A thoroughly researched, empirically-based explanation of the failures of end-of-life communication & decision-making in the United States.

Barbara A. Reich (Author)

9781108486804, Cambridge University Press

Hardback, published 17 March 2022

250 pages
23.5 x 15.8 x 2.1 cm, 0.525 kg

'This insightful, clinically relevant volume does reveal the challenges and obstacles related to the quality of end-of-life care in the US. It should be read by all palliative care physicians, hospice social workers and chaplains, and those seeking a clinically applicable understanding of end-of-life care … Recommended.' A. W. Klink, Choice

In Intimations of Mortality, Barbara Reich offers an empirically-based critique of the failures of end-of-life communication and decision-making in the United States. Using England and Canada as occasional foils, Reich explores why U.S. physicians, patients, and families struggle to have the conversations necessary to provide seriously ill and dying patients with medical care consistent with their preferences. Reich also shows how a number of different factors –including payment mechanisms, liability fears, cultural phenomena, communication avoidance, death denial, and clinical uncertainty –impact physician-patient communication and medical decision-making, leave patients and families without the tools they need to make informed choices, and instead leave the default practices in place. Ultimately, this groundbreaking analysis unveils the interconnectedness of the many obstacles to better communication and decision-making in end-of-life communications and offers much-needed suggestions for improvement.

Preface
Acknowledgements
1. The Conundrum: How Much Medical Care is 'Enough'?
2. Our Health Care 'System': The Good, the Bad, and the Probably Unfixable
3. Autonomy and Informed Consent in the Real World
4. The Denial of Death and Its Sequelae
5. Disorders of Consciousness and the Meaning of Life
6. More Barriers to Good Communication
7. Palliative and Hospice Care: Misunderstandings and Lost Opportunities
8. Rational Apathy and the Role of Uncertainty
9. The Crucible: Making Decisions for Incapacitated Patients
10. Resolving Conflicts at the End of Life: Three Models
11. What's a Pragmatist to Do?
12. At the End of the Day
Index.

Subject Areas: Medical ethics & professional conduct [MBDC], Medical & healthcare law [LNTM]