I t was baroness julia neuberger who described the nhs as a theological institution in the pages of this journal bmj 1999319 1588 9 randall and downies new book in which they argue that end of life care has become overprofessionalised is not so much a philosophy of palliative care as a theological tract in treating the oxford textbook of palliative medicine as a sacred text the . As this palliative care approach advances it is important to pause and comment on its effectiveness it is a philosophy of patient care and is therefore open to critique and evaluation using the oxford textbook of palliative medicine 3rd edition as their basic reference the authors present their. However evaluating the quality of palliative care is difficult for several reasons including the concurrent goals of supportive and curative care the potentially competing interests of patients. The main headings are briefly quality of life autonomy relatives control of symptoms resuscitation and advanced statements psychological and spiritual needs resource allocation and an overview of critique and reconstruction these sound and are familiar yet they are suffused with a new clarity that is a pleasure to read
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