Dr. Joseph J. Fins, Chief of the Division of
Medical Ethics at Weill Medical College
of Cornell University and Director of
Medical Ethics at New York-Presbyterian
Hospital, has written a new book, A
Palliative Ethic of Care: Clinical Wisdom
at Life's End, which addresses end-of-life
care on a practical level.
Although palliative care has grown
tremendously in the last 15 years, there are
still many aspects that are misunderstood
by practitioners and patients alike,
including simply bringing up the subject.
Patients sometimes feel obligated to try
every possible treatment and they don't
want to fail their doctors. Doctors often
misinterpret their patient's wish to die as
an expression of depression.
Seeing a need for a more practical
approach to meeting a patient's needs, Dr.
Fins developed the Goals of Care
Assessment Tool (GCAT). The intent of GCAT is to allow the patient's goals to
dictate appropriate care – regardless of
whether the care is "curative or palliative." Other tools advocated by Dr. Fins which
help define a patient's goals include
advance directives, which indicate who
should make health care decisions should
the patient become incapacitated (ideally
based on previous input from the patient);
a living will, which defines treatment
guidelines; and instructions as to whether
or not a patient wishes to be resuscitated.
GCAT helps patients, practitioners, and
family members collaborate to make sure
the patient is respected as a person and is
allowed to keep their dignity. "The goal is
to help people have a better quality of life – and, when the time comes, quality of
death," states Dr. Fins.
Source: global.med.cornell.edu, 11-18-05
