The practice of palliative care and hospice is filled with overt and sometimes covert ethical challenges. These challenges are addressed by leading international palliative care and hospice scholars under three main domains: care delivery systems; addressing the many dimensions of suffering; and difficult decisions near the end of life.

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues.

This outstanding essay collection, edited by Quill (Univ. of Rochester) and Miller (National Institutes of Health), provides a survey of the clinical and ethical dilemmas clinicians face in palliative care contexts, mainly, but not exclusively, at life's end. The volume helpfully provides perspectives from the diverse disciplines represented in a contemporary palliative care team, general physicians, psychiatrists, nurses, etc. and the diverse locations in which palliative care takes place, from in-home hospice to inpatient hospital settings.