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End-of-Life Care in Medical Textbooks
- Annette T. Carron, DO;
- Joanne Lynn, MD; and
- Patrick Keaney, BS
Improvement in end-of-life care has become a demand of the public and a priority for health care professionals. Medical textbooks could support this improvement by functioning as educational resources and as reference material. In this paper, four widely used general medical textbooks are assessed for their coverage of nine content domains for 12 illnesses that often cause death; each domain in each disease and in each text was graded for presence and helpfulness of advice. Helpful information was rare, and only prognostication and medical treatments to alter the course of the disease were usually mentioned. Harrison's Textbook of Medicine, TheMerck Manual, and Scientific American Medicine often mentioned at least a few of the domains in each disease, although not often in a way that would guide a clinician. Manual of Medical Therapeutics (The Washington Manual) includes little information about end-of-life care.
Improvement seems possible. Short additions of information on end-of-life care would probably be effective. Many chapters discussed at length certain topics that are clearly optional; other textbooks addressed these topics only briefly. When dealing with end-of-life care, physicians should seek guidance from other sources and textbook authors and editors should improve the utility and completeness of their texts.
Until the past 50 years, death usually closely followed an infection or accident; now, most people die slowly of failing organs or cancer. Living with an eventually fatal illness routinely encompasses years. Health care is just beginning to change so that dying people can expect to live comfortably and meaningfully.
The anxiety of persons in the United States about end-of-life care has been fueled by newspaper stories of care gone wrong, debates over physician-assisted suicide (1, 2), personal experience, and research reporting the experience of defined populations (3-6). In response, several steps have been taken. The …
