The main purpose of this book is to bring together some description of
the skills and attitudes of those working in the hospice units
specializing in terminal care with those rather different but
overlapping skills used daily in the palliation of chronic or incurable
disease. This varied collection of papers does not pretend to be
exhaustive. Among the omissions, for example, are two major causes of
deat- chronic respiratory disease and stroke. This is because the
treatment of the end-state of these conditions - and they are not alone
in this - lies more in the gentle withdrawal of measures no longer
appropriate rather than in any positive regime within the gift of the
physician. This may lead on occasion to an unjustifiable diminution of
interest, but this is less likely in cases of cardiac or malignant
disease. Ischaemic heart disease remains the main killer of the western
world. We may see important changes in our approach over the next decade
as we document slowly and painstakingly the comparative ineffectiveness
of our therapy; but in cases of progressive cardiac disease no matter
how we may argue as to management or prevention, we are agreed that we
must lighten the dreary burden of illness as effectively as possible.