The Dying Patient: The Medical Management of Incurable and Terminal Illness

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The main purpose of this book is to bring together some description of the skills and attitudes of those working in the hospice units specializing in terminal care with those rather different but overlapping skills used daily in the palliation of chronic or incurable disease. This varied collection of papers does not pretend to be exhaustive. Among the omissions, for example, are two major causes of deat- chronic respiratory disease and stroke. This is because the treatment of the end-state of these conditions - and they are not alone in this - lies more in the gentle withdrawal of measures no longer appropriate rather than in any positive regime within the gift of the physician. This may lead on occasion to an unjustifiable diminution of interest, but this is less likely in cases of cardiac or malignant disease. Ischaemic heart disease remains the main killer of the western world. We may see important changes in our approach over the next decade as we document slowly and painstakingly the comparative ineffectiveness of our therapy; but in cases of progressive cardiac disease no matter how we may argue as to management or prevention, we are agreed that we must lighten the dreary burden of illness as effectively as possible.