"Hard Choices for Loving People" by Hank Dunn

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"Hard Choices for Loving People": CPR, Artificial Feeding, Comfort Care and the Patient with a Life-Threatening Illness, Fourth Edition
by Hank Dunn (ISBN 1-928560-03-2)

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Since the first edition came off the presses in 1990 over TWO MILLION copies of Hard Choices for Loving People has been sold to hospitals, nursing homes, hospice programs and faith communities nationwide. Now it is available in the Fourth Edition, which came out in 2001. Author Hank Dunn, a nursing home and hospice chaplain for 17 years, has thoroughly researched the medical literature and presented the facts to the reader in a style that is easy for the layperson to understand.

Not only is the style of writing easy to understand but the format of the book also increases the clarity of the material. Every chapter has a few questions at the beginning that serve as an overview and at the end there is a summary. These summaries are designed to help people who have difficulty reading to at least understand the main points of the chapter.

Hard Choices covers the most common medical treatment decisions faced by those who are living with a life-threatening illness. CPR (resuscitation efforts), artificial feeding, hospitalization of an ill person and shifting to a hospice approach are all considered in depth. Besides these most common treatment decisions, there are sections on ventilators, dialysis, antibiotics and pain control. Also, at the end of the chapters on CPR, Artificial Feeding and Comfort Care/Hospice there is a section on making these treatment choices for children. This book is not just for the elderly but for anyone facing a life-threatening illness.

The text is footnoted with almost 100 references to medical research. Here are just a few of issues discussed. CPR continues to be of little help to three categories of patients: those with multiple diagnoses; those with a terminal illness; and those who do not live independently. Recent research has confirmed what many in healthcare have suspected that feeding tubes are not beneficial and can even be harmful to advanced dementia patients. Other studies found that 50% of advanced dementia patients who are hospitalized for a hip fracture or pneumonia die within six months as compared to 13% of noncognitively impaired patients. The section on pain control is written to help patients and families understand how pain is effectively controlled. Among other points, the section clearly states that patients cannot become addicted to pain medications and that slowly increased doses of narcotics cannot kill a patient, no matter how high the dose.

The final chapter, "The Journey to Letting Go," explores the emotional and spiritual issues patients and families confront as they consider the end of life. In Chaplain Dunn's opinion, these are the issues that make end-of-life decisions so difficult.


Introduction

* The Four Most Common Decisions
* Goals of Medical Care

Chapter One - Cardiopulmonary Resuscitation

* Survival Rates with CPR
* CPR in Nursing Homes
* Burdens of CPR
* CPR and the Patient with a Life-Threatening Illness
* CPR with Children
* CPR Is the Standard Order

Chapter Two - Artificial Hydration and Nutrition

* Intravenous (IV) Artificial Hydration
* The Burdens of Artificial Feeding
* The Case For Artificial Feeding in All Circumstances
* The Case Against Artificial Feeding in Some Circumstances
* Would Withholding or Withdrawing Artificial Feeding Cause a Painful Death?
* The Difference Between Withholding and Withdrawing
* Artificial Feeding and the Dementia Patient
* Artificial Feeding and Children
* A Time-Limited Trial

Chapter Three - Cure Sometimes-Comfort Always:

* Hospice, Palliative Care and the "Comfort Care Only" Order
* Goals of Medical Treatment in the "Last Phase of Life"
* Hospice
* What Are Comfort Measures?
* Which Medical Treatments Are Optional?
* Which Patients Are Candidates for Hospice or Comfort Care Only? When Is the Right Time?
* End-Stage Dementia and Comfort Care Only
* Children and Comfort Care Only
* Turning From Cure to Comfort Care Only

Chapter Four - Treatments To Consider-Practical Help for Decisionmaking

* Hospitalization
* Ventilators
* Dialysis
* Antibiotics
* Pain Control
* Some Practical Help for Making Decisions
* What To Do
* Questions To Help Make a Decision
* Getting Help With End-of-Life Decisions

Chapter Five - The Journey to Letting Go

* A Personal Word From a Chaplain-The Four Treatment Decisions .
* Changing the Treatment Plan
* The Emotional Nature of the Struggle
* Treating the Wrong Patient
* Can I Let Go?
* A Lifetime of Letting Go
* Some Religious Questions
* The Spiritual Nature of the Struggle
* Giving Up and Letting Go
* Fatal Isn't the Worst Outcome