On Making Compassion Tangible

Abstract

A Palliative Ethic of Care: Clinical Wisdom at Life's End. By Joseph F. Fins. Jones & Bartlett, 2005. 281 pages. Softcover, $42.95 I have written this book because I have faith in the individual practitioner--my colleagues in the helping professions. I believe that most of us came to practice with idealism and a desire to make a difference in the world, if only we could be directed how to make compassion tangible (p. xxii). Thus does Joseph Fins preface A Palliative Ethic of Care, which has much to teach all who care for the dying. Fins writes from the conviction that is at the heart of such care and that, with proper guidance, medical students and residents can learn to cultivate such wisdom. A self-described reformer, Fins advocates clinical pragmatism, an approach to patient care and ethics consultation that draws on the work of John Dewey. Dewey's contextual analysis of ethically problematic situations strongly resembles the reasoning clinicians engage in to arrive at a differential diagnosis. The first third of the book reviews relevant ethical, legal, and institutional developments in caring for the dying in America since the 1960s. Part II elaborates a practical strategy for effective palliative care using an assessment tool the author and his colleagues developed to help clinicians transition from curative to palliative care. This strategy should become indispensable to planning such care, especially in institutional settings where the principal focus tends to be on rescue and cure. It presupposes a team approach to care and directs attention to clinician and patient (or surrogate) perceptions of the patient's condition, end of life care options (including withholding or withdrawing life-sustaining therapies), and changes in the patient's condition that may prompt a corresponding alteration in management (including considering intensive care as well as comfort measures to relieve pain and distress). That said, where does the wisdom of the book's subtitle come in? Fins begins the book with a fictional vignette in which he conjures a medical student who is feeling uncertain and uncomfortable in the presence of a dying patient. Just then, an admired senior physician enters the room, adjusts the patient's facemask and pillows and elevates the bed just a bit. She places a hand on the patient's shoulder and offers a comforting word. You don't quite hear what she says, but you can tell that the patient was consoled by the change in his expression. …