Module 11: Terminal Illness
Upon completion of this module, the resident should be able to:
- Describe the evolution of dying and death in the United States over the last century or so.
- Enumerate the findings of the landmark SUPPORT study and describe the significance of these as well as the findings from other studies for the quality of dying and death in the United States.
- Identify the foci and goals of palliative and hospice care.
- Describe the ethical controversy surrounding the practice of palliative sedation.
- Describe the consensus and controversial ethical "principles" that apply to the care and treatment of patients with serious or terminal illness.
- Describe and evaluate "opposing" positions on the question of whether medical futility can be defined and, if so, how.
Joan Teno and her colleagues at Brown University have been pioneers in the empirical study of caring for patients with serious or terminal illness and in the development of tools for improving such care. Much of the fruits of their labor is available at: http://www.chcr.brown.edu/pcoc/toolkit.htm and http://www.chcr.brown.edu/pcoc/resourceguide/resourceguide.pdf.
The Medical College of Wisconsin maintains an excellent resource, End-of-Life and Palliative Education Resource Center, at: http://www.eperc.mcw.edu/. Especially useful are the “fast facts and concepts” on a wide range of topics in end of life care.
Because pain is unavoidably subjective phenomenon, it is often difficult to measure. A series of illustrations, charts, and numerical scales for surmounting this impediment can be found at: http://painconsortium.nih.gov/pain_scales/index.html.
The website of the Center for the Advancement of Palliative Care can be found at: http://www.capc.org/.
The Department of Pain Medicine and Palliative Care at Beth Israel Hospital has a website with a wide range of resources, including online continuing medical education, in pain medicine and palliative care. It can be found at: http://www.stoppain.org/.
A brief but comprehensive on-line course in end of life care for physicians can be found at: http://endlink.lurie.northwestern.edu/.
The comprehensive report of the New York State Task Force on Life and the Law, When Death Is Sought: Assisted Suicide and Euthanasia in Medical Context, is available at: http://wings.buffalo.edu/faculty/research/bioethics/WDIS.html.