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End-of-Life Decisions

A Psychosocial Perspective

Edited by Maurice D. Steinberg, M.D., and Stuart J. Youngner, M.D.

  • ISBN 978-0-88048-756-6
  • Item #8756

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In recent years, the lens of the media has narrowed issues of euthanasia and assisted suicide to a drama involving two players: Dr. Kevorkian and the law. This has left suffering patients and their families unrecognized and isolated when facing the most painful life decision.

Here at last is a book that addresses the role of psychiatry in dealing with a major, controversial topic in American medicine today—treatment decisions at the end of life. End-of-Life Decisions: A Psychosocial Perspective acknowledges and explores the role psychiatrists can play as advisers to the terminally ill and their loved ones. It describes the wide range of emotional and psychiatric issues faced by the patient, family, and physician that affect choices patients make to limit treatment or seek physician assistance in dying.

A distinguished group of contributors, all of whom have extensive experience dealing with end-of-life issues in clinical practice, address topics that may not have been considered previously. From dealing with issues of terminal illnesses in children, to making difficult treatment decisions for patients with AIDS; from judging the competency of clinically depressed patients for making sound decisions, to understanding the influence of family dynamics, economic forces, and language differences on doctor-patient communication—the book uses specific case studies and data to explore the role of professionals in end-of-life decisions.

End-of-Life Decisions strikes a careful balance between the need for patient autonomy and the challenge to make well-formulated treatment decisions. This book will heighten modern medicine's and society's consciousness concerning the difficult challenges faced by patients and their families when making end-of-life decisions


  • Foreword. Introduction. Competence to refuse life-sustaining treatment. Depression and the refusal of life-saving medical treatment. Family dynamics in decisions to withhold or withdraw treatment. Obstacles to doctor-patient communication at the end of life. Consultation to end-of-life treatment decisions in children. End-of-life decisions in AIDS. Patient requests for euthanasia and assisted suicide in terminal illness: the role of the psychiatrist. Legal aspects of end-of-life decision making. Termination of treatment decisions: ethical underpinnings. Physician-assisted suicide: moral questions. Index.

About the Authors

Maurice D. Steinberg, M.D., is Consultation-Liaison Psychiatrist, Associate Director of the C-L Psychiatry Service, and Director of Fellowship Programs in C-L Psychiatry at the Long Island Jewish Medical Center. He has been the Chairman of the APA's subcommittee on Psychiatric Aspects of Life Sustaining Technology since its inception in 1992 , and Chairman of the Academy of Psychosomatic Medicine's Task Force on Bioethics and the Role of the Psychiatrist, since 1993. He was a member of the APA's committee on C-L Psychiatry and Primary Care Education from 1989 to 1995. Dr. Steinberg has chaired or presented papers at numerous symposia of the APA, the Academy of Psychosomatic Medicine, and the American Psychosomatic Society on issues of limiting medical treatment, physician-assisted suicide and bioethics, as well as teaching psychiatry to primary care physicians.

Stuart J. Youngner, M.D., is Professor of Medicine, Psychiatry, and Biomedical Ethics at Case Western Reserve University and Director of the Clinical Ethics Progam at University Hospitals of Cleveland. Dr. Youngner has had a long interest in the interface between psychiatry and ethics in end-of-life care and has written and spoken widely on topics including: DNR decisions, clinical ethics consultation, advance directives, definitions of death, and ethical issues in organ retrieval and transplantation. He served as President on the Society for Bioethics Consultation from 1994-1997 and serves on the Board of Directors of the American Society for Bioethics and Humanities. Dr. Youngner is currently conducting research on end-of-life decisions in Cuba where he holds an appointment as Adjunct Professor at the Institute of Advance Medical Sciences in Havana.

Medical and mental health professionals will find this book useful in analyzing issues surrounding psychiatric contributions in end-of-life decision making. Ethicists will benefit from chapters on psychosocial dynamics as adding necessary clinical sophistication to their theoretical considerations of this important topic.—Religious Studies Review

End-of-Life Decisions is an important book. It does much more than offer readers a psychosocial perspective. There is searching thought, clinical experience, legal expertise, and even moral commentary about the role of physicians in ending life.—Alan A. Stone, M.D., Professor of Law and Psychiatry, Harvard Law School, Cambridge, Massachusetts

End-of-Life Decisions highlights the special role that psychiatrists play as patients make decisions near the end of their lives; from treating the conditions that impair patients' decision making, to dealing with family dynamics in choices to withhold care, to overcoming obstacles to meaningful communication between doctors and patients. Every psychiatrist will come away from this book with new direction and inspiration for dealing with these commonplace, but difficult situations. It is a tremendously useful work.—Paul S. Appelbaum, M.D., A. F. Zeleznik Professor and Chair, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts

Drs. Steinberg and Youngner have put together a collection of thoughtful and thorough essays on psychosocial and ethical aspects of end-of-life decisions. This book fills a gap in the growing literature on end-of-life decisions, covering everything from depressed patients to the role of the family to physician-assisted suicide. Contributors present actual cases from their own clinical experience, enriching a volume that is both highly readable and informative. I recommend it highly.—Ruth Macklin, Ph.D., Professor of Bioethics, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York

This timely volume is written by a panel of experts which draws heavily on consultation-liaison psychiatrists who are experienced and knowledgeable about end-of-life decisions. It includes chapters dealing with the legal and ethical issues by outstanding ethicists and a lawyer. Steinberg and Youngner have put together this most valuable book which will serve equally to educate professionals in mental health and medicine. The psychosocial perspective must receive increased attention if we are to provide the most rational, thoughtful, and effective care for patients and give help to the families who must share in the burden of decisions. This book summarizes the psychosocial perspective on care at the end of life—it makes a unique contribution to the literature.—Jimmie Holland, M.D., Chair, Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Professor and Vice-Chair, Department of Psychiatry, Cornell Univ Medical College

This book is a good introduction for the psychiatrist who wishes to work with terminally ill patients in a palliative care setting, but who has not had significant clinical experience working with this special population.—Doody's Health Sciences Book Review Journal

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