SlideShare a Scribd company logo
1 of 9
Download to read offline
Literature review created for required writing sample
for application to academic admission, 2008
© 2008/2014 by Dawn Drake
© 2008/2014 by Dawn Drake
1
A Critical Review of Lieff, J. (1982). Eight reasons why doctors fear the
elderly, chronic illness, and death. The Journal of Transpersonal Psychology, 14(1),
47-60.
Literature Review
Jonathan Lieff, author of this article, holds a B.A. from Yale College and an
M.D. from Harvard Medical College, and is board certified by the American Board of
Psychiatry (Ages Health Services Inc., 1996). When the article was published in
1982, Lieff had developed services for elderly, handicapped, and terminally ill
patients in connection with the Boston Housing Authority, nursing homes, and
hospitals. He had also served as Director of Geriatric Fellowship at Boston
University and Chief of Geriatrics at Lemuel Shattuck Hospital, a Tufts University
Facility.
In this paper, I summarize the article and offer comments about selected
aspects, identify some relevant changes that have occurred since the article was
published, and suggest areas where additional research findings would assist in
understanding the current state of medical care in regard to the issues raised.
Article Summary
Lieff (1982) described recent (at the time of publication) research findings
that indicated “widespread and well-documented prejudice” (p. 47) against elderly
and terminally ill patients, and that suggested prejudice and avoidance behaviors
were fostered in American medical schools. He also documented benefits of
psychological support for dying patients and then identified and discussed eight
© 2008/2014 by Dawn Drake
2
reasons to explain the fear that he believed could explain doctors’ behaviors toward
these patients. Many of his explanations reflected spiritually related problems that
he believed were at the root of the issue. Lieff (1982) did note that some medical
professionals, mostly not physicians (i.e., nurses, social workers, therapists, and
some physicians who find personal reward in providing elder-care), countered the
norm by providing more effective services to the elderly. After discussing the
relevance of the spiritual needs of the dying, Lieff (1982) concluded by positing the
need for an increased professional emphasis on the “psychological and spiritual
considerations” (p. 59) of the final stage of life.
Critical Reflections
The dominant purpose of this article seems to be to convince the reader that
Western doctors (specifically, American doctors) were not prepared to support the
emotional and spiritual needs of the patients who were dying, and further, that
spiritual training should be included as a standard component of medical training
for doctors. All of the reasons for fear that Lieff (1982) discussed reflected
psychological or spiritual issues; consideration of other contributing factors was
noticeably lacking. Although Lieff (1982) offered persuasive ideas to explain why
doctors might fear chronically ill and terminal patients, many of his descriptions of
doctors’ attitudes and experiences included neither research references nor
acknowledgement that the statements were his opinions—presumably based on his
experiences in the profession, but opinions, nonetheless. Examples include
assertions (Lieff, 1982) that many doctors did not recognize the human potential to
© 2008/2014 by Dawn Drake
3
transcend physical limitations and find personal fulfillment, that doctors lacked
resources for finding “information about the purpose of the ending of life, and of
death” (p. 55), that most doctors were not prepared to deal with the impact that
religious beliefs or experiences had on the efficacy of medical treatment, and that
our society had given doctors “a kind of priestly status” (p. 58).
Acknowledging his comments as opinions or personal observations and then
explaining his reasoning could have provided an opportunity to persuade a skeptical
reader to agreement. By offering neither research findings nor personal reasoning,
Lieff potentially increased the reader's resistance to his arguments. Numerous
statements also seem to express Lieff's (1982) own frustration in coming to terms
with death and dying, especially within American society. For example,
Patients and their families generally turn to the physician for solutions to
these problems, . . . The typical doctor is perhaps no better prepared to take
care of his own elderly parents and grandparents . . . But they are expected
magically to provide solutions (p. 55).
Theorists, such as Erikson (1963) and Lidz (1976), attempt to include the
termination of life as a psychological developmental stage. But what
psychological development leads to death? (p. 56)
In a medical system that lacks a spiritual basis for making decisions, it is not
acceptable to die without a medical cause. This is just one of many ways in
which the doctor is rendered helpless in a system which is structured to help
him hide these feelings of helplessness (p. 58).
Upon recognizing this undertone of personal frustration, the reader might
question the objectivity, and therefore the validity, of the overall argument. This, in
conjunction with the lack of support for many of the assertions made, undermines
the potential benefit of Lieff's (1982) presentation of the issues.
© 2008/2014 by Dawn Drake
4
Further Research
Lieff (1982) supported Kastenbum’s recommendations for providing patient-
oriented standards, but expressed reservations about the whether those
recommendations could be successfully implemented in America. Lieff (1982)
suggested that hospices, which were rare in the U.S. in 1982—only about 1,500
programs existed by 1985 (National Hospice and Palliative Care Organization,
n.d.)—might provide a satisfactory model for end-of-life care. Changes have
occurred in American society that have dramatically altered the circumstances that
existed when Lieff (1982) wrote this article. Some pivotal ones that directly affected
medical care are
• in 1983, Medicare began paying for hospice care for eligible patients (von Guten
& Ferris, 2002),
• in 1997, Geriatric Psychiatry was approved as an official subspecialty (American
Board of Psychiatry and Neurology, Inc., n.d.),
• in 2006, the subspecialty of Hospice and Palliative Medicine (HPM) was
approved (American Board of Medical Specialties, 2006; palliative care provides
treatment to alleviate pain and symptoms without treating the underlying
cause), and
• according to the National Hospice and Palliative Care Organization (2007), in
2006 the number of hospice programs in the U.S. had grown to 4,500, serving an
estimated 1.3 million patients, and more than one third of all deaths in the
United States that year occurred in a hospice program.
© 2008/2014 by Dawn Drake
5
These changes suggest that a significant shift has occurred, or is occurring, in
the way the medical community views elderly and terminally ill patients, but they
don’t tell us the source or reason for the change. The research cited by Lieff (1982)
needs to be revalidated, especially in regard to whether prejudicial attitudes and
avoidance behaviors are still demonstrated in medical schools and among practicing
physicians, and what psychiatric treatment is provided to elderly and terminally ill
patients. It would also be appropriate to look for other factors besides the fear that
might contribute to those attitudes and behaviors.
Lieff’s (1982) comments also raised several other issues that suggest further
research opportunities. He noted that nurses, social workers, and therapists were
leading the way in providing better care for the elderly. How do their ways of
treating and interacting with patients differ from physicians? Do they have
different attitudes about patients or perspectives on life and death? What is the
source of any differences? If they learned the methods and attitudes in a formal
setting, how were those alternatives taught? Are those methods transferable to
physician training, and if so, has there been progress in incorporating those changes
into medical schools? How do patients and their families perceive the care that the
nurses and other care providers deliver in contrast to the care that is provided by
physicians? Do these patients and their families communicate their feelings to
others, and if so, has it effected any change in expectations in those others? How do
doctors respond to these methods—are they supportive, obstructive, or neutral?
What consequences do these practioners experience, and how does that affect their
© 2008/2014 by Dawn Drake
6
motivation to continue with their methods? And, of course, how many physicians
are entering the new subspecialties that are targeted to treating these patients?
Lieff (1982) suggested that physicians should receive more spiritual training,
based on his assessment of their fears. It would be appropriate to conduct current
research to determine whether his assessments are correct in regard to today’s
physicians; for example, whether doctors believe that they have a “priestly status”
(Lieff, 1982, p. 58) in our society and that they are ill prepared ethically and morally
“beyond obeisance to academic and guild organizations” (p. 58), whether death
certificate requirements make them feel helpless, and whether they refer patients
to specialists for assistance in coping with “problems of meaning and purpose” (p.
54). Research into doctors’ opinions about including spiritual orientation in medical
training would be important, and if they support the idea, what methods they would
consider acceptable for determining the content and delivery of that training. This
article raises issues and possibilities that are rife with questions worthy of
exploration. Additional examination should quickly raise research possibilities
beyond those suggested above.
Conclusion
Lieff (1982) presented convincing research that chronically ill and terminal
patients need psychological support, yet many American doctors exhibited
avoidance behaviors toward them in the early 1980s. It appears, though, that Lieff’s
primary goal was to persuade the reader that spiritual training should be included
in American medical training. Because he focused primarily on spiritual issues,
© 2008/2014 by Dawn Drake
7
positioned opinions as facts, and conveyed an undercurrent of frustration, the
article is subject to being discounted as fallacious rather than being accepted as an
objective, scholarly treatment of a legitimate professional concern.
More than a quarter of a century has passed since the article was published,
and in that time, significant changes have occurred in the medical field that affect
how terminally ill patients are treated in the U.S. Given the growing population of
the elderly and the seriousness of the concerns raised by Lieff (1982), current
research into medical training practices and the need and appropriate goals for
including spiritual training in medical education curricula seems both appropriate
and important to ensuring that a high quality of compassionate and effective care
will be available to individuals who are reaching the end of their life.
© 2008/2014 by Dawn Drake
8
References
Ages Health Services Inc. (1996). Form 10-KSB/A-1 Annual Report Pursuant to
Section 13 or 15(d) of the Securities Exchange Act of 1934. Retrieved from
http://www.secinfo.com—drP9x.81v.htm
American Board of Medical Specialties. (2006). News release: ABMS establishes
specialty certificate in hospice and palliative medicine. Retrieved April 30,
2008, from http://www.nhpco.org/i4a/pages/index.cfm?pageid=5072
American Board of Psychiatry and Neurology, Inc. (n.d.). Initial Certification in the
Subspecialty of Geriatric Psychiatry. Retrieved from
http://www.abpn.com/gp.htm
National Hospice and Palliative Care Organization (NHPCO). (n.d.). Growth in U.S.
hospice programs: 1974 to 2006. Retrieved from
http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-
figures_Nov2007.pdf
National Hospice and Palliative Care Organization (NHPCO). (2007). NHPCO facts
and figures: Hospice care in America. Retrieved from
http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-
figures_Nov2007.pdf
von Gunten, C. F., & Ferris, F. D. (2002). CAPC manual: Everything you wanted to
know about establishing a palliative care program but were afraid to ask.
Retrieved from
http://64.85.16.230/educate/content/rationale/ushospicegrowth.html

More Related Content

What's hot

Apa article summary example
Apa article summary exampleApa article summary example
Apa article summary exampleAyesha Yaqoob
 
Format APA: Panduan Asas dan Mudah
Format APA: Panduan Asas dan MudahFormat APA: Panduan Asas dan Mudah
Format APA: Panduan Asas dan MudahKee-Man Chuah
 
Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2
Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2
Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2surrenderyourthrone
 
Script for english meeting
Script for english meetingScript for english meeting
Script for english meetingroseate92
 
Slides presentation example for proposal defence
Slides presentation example for proposal defenceSlides presentation example for proposal defence
Slides presentation example for proposal defencePuan Molek Mohd Rais
 
Tajuk 2 Falsafah dalam Kehidupan
Tajuk 2 Falsafah dalam KehidupanTajuk 2 Falsafah dalam Kehidupan
Tajuk 2 Falsafah dalam KehidupanMahyuddin Khalid
 
Example of Company background
Example of Company backgroundExample of Company background
Example of Company backgroundfazzuan
 
Tajuk 3 Logik dan Metodologi
Tajuk 3 Logik dan MetodologiTajuk 3 Logik dan Metodologi
Tajuk 3 Logik dan MetodologiMahyuddin Khalid
 
Cara penulisan-bibliografi (apa style)
Cara penulisan-bibliografi (apa style)Cara penulisan-bibliografi (apa style)
Cara penulisan-bibliografi (apa style)Ila Ali
 
Topik 2 konsep etika dan peradaban
Topik 2 konsep etika dan peradabanTopik 2 konsep etika dan peradaban
Topik 2 konsep etika dan peradabanSharifahNurAbu
 
ABCat Cafe & Studio (ENT530 - Business Plan)
ABCat Cafe & Studio (ENT530 - Business Plan)ABCat Cafe & Studio (ENT530 - Business Plan)
ABCat Cafe & Studio (ENT530 - Business Plan)HarithDaniel9
 
INTERNSHIP REPORT NATASHA NAZIRA
INTERNSHIP REPORT NATASHA NAZIRAINTERNSHIP REPORT NATASHA NAZIRA
INTERNSHIP REPORT NATASHA NAZIRANatasha Nazira
 
Example script for moderator
Example script for moderatorExample script for moderator
Example script for moderatorAde Johan
 
Hubungan Etnik - Konsep Asas
Hubungan Etnik - Konsep AsasHubungan Etnik - Konsep Asas
Hubungan Etnik - Konsep AsasMahyuddin Khalid
 
ELC501- Analysis summary
ELC501- Analysis summaryELC501- Analysis summary
ELC501- Analysis summaryHazwani Mohamad
 
Writing an evaluative commentary
Writing an evaluative commentaryWriting an evaluative commentary
Writing an evaluative commentaryjosephraj007
 

What's hot (20)

Apa article summary example
Apa article summary exampleApa article summary example
Apa article summary example
 
Format APA: Panduan Asas dan Mudah
Format APA: Panduan Asas dan MudahFormat APA: Panduan Asas dan Mudah
Format APA: Panduan Asas dan Mudah
 
Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2
Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2
Soalan dan Jawapan - Hubungan Etnik (Kuiz/Past Year) 2
 
Example of acknowledgment
Example of acknowledgmentExample of acknowledgment
Example of acknowledgment
 
Script for english meeting
Script for english meetingScript for english meeting
Script for english meeting
 
Slides presentation example for proposal defence
Slides presentation example for proposal defenceSlides presentation example for proposal defence
Slides presentation example for proposal defence
 
Tajuk 2 Falsafah dalam Kehidupan
Tajuk 2 Falsafah dalam KehidupanTajuk 2 Falsafah dalam Kehidupan
Tajuk 2 Falsafah dalam Kehidupan
 
Example of Company background
Example of Company backgroundExample of Company background
Example of Company background
 
Tajuk 3 Logik dan Metodologi
Tajuk 3 Logik dan MetodologiTajuk 3 Logik dan Metodologi
Tajuk 3 Logik dan Metodologi
 
Cara penulisan-bibliografi (apa style)
Cara penulisan-bibliografi (apa style)Cara penulisan-bibliografi (apa style)
Cara penulisan-bibliografi (apa style)
 
Topik 2 konsep etika dan peradaban
Topik 2 konsep etika dan peradabanTopik 2 konsep etika dan peradaban
Topik 2 konsep etika dan peradaban
 
ABCat Cafe & Studio (ENT530 - Business Plan)
ABCat Cafe & Studio (ENT530 - Business Plan)ABCat Cafe & Studio (ENT530 - Business Plan)
ABCat Cafe & Studio (ENT530 - Business Plan)
 
INTERNSHIP REPORT NATASHA NAZIRA
INTERNSHIP REPORT NATASHA NAZIRAINTERNSHIP REPORT NATASHA NAZIRA
INTERNSHIP REPORT NATASHA NAZIRA
 
Example script for moderator
Example script for moderatorExample script for moderator
Example script for moderator
 
Hubungan Etnik - Konsep Asas
Hubungan Etnik - Konsep AsasHubungan Etnik - Konsep Asas
Hubungan Etnik - Konsep Asas
 
Panduan penulisan APA
Panduan penulisan APAPanduan penulisan APA
Panduan penulisan APA
 
Materialisme
MaterialismeMaterialisme
Materialisme
 
ELC501- Analysis summary
ELC501- Analysis summaryELC501- Analysis summary
ELC501- Analysis summary
 
Tajuk 4 Konsep Insan
Tajuk 4 Konsep InsanTajuk 4 Konsep Insan
Tajuk 4 Konsep Insan
 
Writing an evaluative commentary
Writing an evaluative commentaryWriting an evaluative commentary
Writing an evaluative commentary
 

Viewers also liked

Writing an article review
Writing an article reviewWriting an article review
Writing an article reviewdapuchak
 
Article Summaries and Critiques
Article Summaries and CritiquesArticle Summaries and Critiques
Article Summaries and Critiquescjturner011075
 
Cover page for article summary
Cover  page for article summaryCover  page for article summary
Cover page for article summaryMiracle06
 
Survey of ohptholmology meta-analysis
Survey of  ohptholmology meta-analysisSurvey of  ohptholmology meta-analysis
Survey of ohptholmology meta-analysisRoss Finesmith M.D.
 
Apa 6th edition introduction
Apa 6th edition introductionApa 6th edition introduction
Apa 6th edition introductionmanobillla
 
Zuraini uitm task drjohan
Zuraini uitm task drjohanZuraini uitm task drjohan
Zuraini uitm task drjohangadislekio12345
 
Assignment article review dr johan
Assignment article review dr johanAssignment article review dr johan
Assignment article review dr johanazlinazlan
 
administration of school financing
administration of school financingadministration of school financing
administration of school financingRuel Manzano
 

Viewers also liked (11)

Article review
Article reviewArticle review
Article review
 
Writing an article review
Writing an article reviewWriting an article review
Writing an article review
 
Article Summaries and Critiques
Article Summaries and CritiquesArticle Summaries and Critiques
Article Summaries and Critiques
 
Cover page for article summary
Cover  page for article summaryCover  page for article summary
Cover page for article summary
 
Survey of ohptholmology meta-analysis
Survey of  ohptholmology meta-analysisSurvey of  ohptholmology meta-analysis
Survey of ohptholmology meta-analysis
 
Apa 6th edition introduction
Apa 6th edition introductionApa 6th edition introduction
Apa 6th edition introduction
 
How To Write A Critical Review
How To Write A Critical ReviewHow To Write A Critical Review
How To Write A Critical Review
 
Zuraini uitm task drjohan
Zuraini uitm task drjohanZuraini uitm task drjohan
Zuraini uitm task drjohan
 
Assignment article review dr johan
Assignment article review dr johanAssignment article review dr johan
Assignment article review dr johan
 
administration of school financing
administration of school financingadministration of school financing
administration of school financing
 
Research critique example rmt 1
Research critique example rmt 1Research critique example rmt 1
Research critique example rmt 1
 

Similar to Article Review-Writing Sample

FOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docx
FOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docxFOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docx
FOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docxbudbarber38650
 
Editing and proof reading for l7
Editing and proof reading for l7Editing and proof reading for l7
Editing and proof reading for l7JAHennessyMurdoch
 
EMPIRICAL STUDYThe meaning of learning to live with medica.docx
EMPIRICAL STUDYThe meaning of learning to live with medica.docxEMPIRICAL STUDYThe meaning of learning to live with medica.docx
EMPIRICAL STUDYThe meaning of learning to live with medica.docxSALU18
 
Mental health palliative_care
Mental health palliative_careMental health palliative_care
Mental health palliative_careLalu Ivan
 
TNAMFT Presentation 2016
TNAMFT Presentation 2016TNAMFT Presentation 2016
TNAMFT Presentation 2016Emily Sullivan
 
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxA NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxransayo
 
Artificial Nutrition And Hydration At The End Of Life
Artificial Nutrition And Hydration At The End Of LifeArtificial Nutrition And Hydration At The End Of Life
Artificial Nutrition And Hydration At The End Of LifeScott Faria
 
NGR 5110 Treating Eating Disorders Reflection.pdf
NGR 5110 Treating Eating Disorders Reflection.pdfNGR 5110 Treating Eating Disorders Reflection.pdf
NGR 5110 Treating Eating Disorders Reflection.pdfbkbk37
 
Health Psychology Cognitive Behavioral Intervention HW.docx
Health Psychology Cognitive Behavioral Intervention HW.docxHealth Psychology Cognitive Behavioral Intervention HW.docx
Health Psychology Cognitive Behavioral Intervention HW.docxbkbk37
 
Rationale and Standards of Evidence in Evidence-Based Practice.docx
Rationale and Standards of Evidence in Evidence-Based Practice.docxRationale and Standards of Evidence in Evidence-Based Practice.docx
Rationale and Standards of Evidence in Evidence-Based Practice.docxmakdul
 
Integrative and Biopsychosocial Approaches in Contemporary Clinica.docx
Integrative and Biopsychosocial Approaches in Contemporary Clinica.docxIntegrative and Biopsychosocial Approaches in Contemporary Clinica.docx
Integrative and Biopsychosocial Approaches in Contemporary Clinica.docxnormanibarber20063
 
Understanding Oncology Nurses’ Grief: A Qualitative Meta-Analysis
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisUnderstanding Oncology Nurses’ Grief: A Qualitative Meta-Analysis
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisLisa Barbour
 
Health Psychology and Depression Research Proposal HW.docx
Health Psychology and Depression Research Proposal HW.docxHealth Psychology and Depression Research Proposal HW.docx
Health Psychology and Depression Research Proposal HW.docxbkbk37
 
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxClinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxgordienaysmythe
 
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxClinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxvernettacrofts
 
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxClinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxmccormicknadine86
 
Multiple Chemical Sensitivities - A Proposed Care Model
Multiple Chemical Sensitivities - A Proposed Care Model Multiple Chemical Sensitivities - A Proposed Care Model
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
 
From Populations to Patients: Social Determinants of Health & Mental Health i...
From Populations to Patients: Social Determinants of Health & Mental Health i...From Populations to Patients: Social Determinants of Health & Mental Health i...
From Populations to Patients: Social Determinants of Health & Mental Health i...Université de Montréal
 
Relapse Prevention In The Dual Diagnosed
Relapse Prevention In The Dual DiagnosedRelapse Prevention In The Dual Diagnosed
Relapse Prevention In The Dual Diagnosedcelenaheine
 

Similar to Article Review-Writing Sample (20)

FOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docx
FOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docxFOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docx
FOCUS ON ETHICSJeffrey E. Barnett, EditorEthics and Mu.docx
 
Editing and proof reading for l7
Editing and proof reading for l7Editing and proof reading for l7
Editing and proof reading for l7
 
EMPIRICAL STUDYThe meaning of learning to live with medica.docx
EMPIRICAL STUDYThe meaning of learning to live with medica.docxEMPIRICAL STUDYThe meaning of learning to live with medica.docx
EMPIRICAL STUDYThe meaning of learning to live with medica.docx
 
Mental health palliative_care
Mental health palliative_careMental health palliative_care
Mental health palliative_care
 
TNAMFT Presentation 2016
TNAMFT Presentation 2016TNAMFT Presentation 2016
TNAMFT Presentation 2016
 
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxA NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx
 
Artificial Nutrition And Hydration At The End Of Life
Artificial Nutrition And Hydration At The End Of LifeArtificial Nutrition And Hydration At The End Of Life
Artificial Nutrition And Hydration At The End Of Life
 
NGR 5110 Treating Eating Disorders Reflection.pdf
NGR 5110 Treating Eating Disorders Reflection.pdfNGR 5110 Treating Eating Disorders Reflection.pdf
NGR 5110 Treating Eating Disorders Reflection.pdf
 
Health Psychology Cognitive Behavioral Intervention HW.docx
Health Psychology Cognitive Behavioral Intervention HW.docxHealth Psychology Cognitive Behavioral Intervention HW.docx
Health Psychology Cognitive Behavioral Intervention HW.docx
 
Rationale and Standards of Evidence in Evidence-Based Practice.docx
Rationale and Standards of Evidence in Evidence-Based Practice.docxRationale and Standards of Evidence in Evidence-Based Practice.docx
Rationale and Standards of Evidence in Evidence-Based Practice.docx
 
Integrative and Biopsychosocial Approaches in Contemporary Clinica.docx
Integrative and Biopsychosocial Approaches in Contemporary Clinica.docxIntegrative and Biopsychosocial Approaches in Contemporary Clinica.docx
Integrative and Biopsychosocial Approaches in Contemporary Clinica.docx
 
Understanding Oncology Nurses’ Grief: A Qualitative Meta-Analysis
Understanding Oncology Nurses’ Grief: A Qualitative Meta-AnalysisUnderstanding Oncology Nurses’ Grief: A Qualitative Meta-Analysis
Understanding Oncology Nurses’ Grief: A Qualitative Meta-Analysis
 
Health Psychology and Depression Research Proposal HW.docx
Health Psychology and Depression Research Proposal HW.docxHealth Psychology and Depression Research Proposal HW.docx
Health Psychology and Depression Research Proposal HW.docx
 
Literature Review On Coffee
Literature Review On CoffeeLiterature Review On Coffee
Literature Review On Coffee
 
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxClinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
 
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxClinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
 
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docxClinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
Clinical Case Studies8(6) 417 –423© The Author(s) 2009.docx
 
Multiple Chemical Sensitivities - A Proposed Care Model
Multiple Chemical Sensitivities - A Proposed Care Model Multiple Chemical Sensitivities - A Proposed Care Model
Multiple Chemical Sensitivities - A Proposed Care Model
 
From Populations to Patients: Social Determinants of Health & Mental Health i...
From Populations to Patients: Social Determinants of Health & Mental Health i...From Populations to Patients: Social Determinants of Health & Mental Health i...
From Populations to Patients: Social Determinants of Health & Mental Health i...
 
Relapse Prevention In The Dual Diagnosed
Relapse Prevention In The Dual DiagnosedRelapse Prevention In The Dual Diagnosed
Relapse Prevention In The Dual Diagnosed
 

Recently uploaded

Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptxraviapr7
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxMYDA ANGELICA SUAN
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxiammrhaywood
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxKatherine Villaluna
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfTechSoup
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptxSandy Millin
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfMohonDas
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17Celine George
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfMohonDas
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesMohammad Hassany
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxDr. Asif Anas
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx
3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx
3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptxmary850239
 

Recently uploaded (20)

Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
Prelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quizPrelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quiz
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptx
 
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptxAUDIENCE THEORY -- FANDOM -- JENKINS.pptx
AUDIENCE THEORY -- FANDOM -- JENKINS.pptx
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdf
 
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdfPersonal Resilience in Project Management 2 - TV Edit 1a.pdf
Personal Resilience in Project Management 2 - TV Edit 1a.pdf
 
How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17How to Use api.constrains ( ) in Odoo 17
How to Use api.constrains ( ) in Odoo 17
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdf
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming Classes
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptx
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx
3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx
3.19.24 Urban Uprisings and the Chicago Freedom Movement.pptx
 

Article Review-Writing Sample

  • 1. Literature review created for required writing sample for application to academic admission, 2008 © 2008/2014 by Dawn Drake
  • 2. © 2008/2014 by Dawn Drake 1 A Critical Review of Lieff, J. (1982). Eight reasons why doctors fear the elderly, chronic illness, and death. The Journal of Transpersonal Psychology, 14(1), 47-60. Literature Review Jonathan Lieff, author of this article, holds a B.A. from Yale College and an M.D. from Harvard Medical College, and is board certified by the American Board of Psychiatry (Ages Health Services Inc., 1996). When the article was published in 1982, Lieff had developed services for elderly, handicapped, and terminally ill patients in connection with the Boston Housing Authority, nursing homes, and hospitals. He had also served as Director of Geriatric Fellowship at Boston University and Chief of Geriatrics at Lemuel Shattuck Hospital, a Tufts University Facility. In this paper, I summarize the article and offer comments about selected aspects, identify some relevant changes that have occurred since the article was published, and suggest areas where additional research findings would assist in understanding the current state of medical care in regard to the issues raised. Article Summary Lieff (1982) described recent (at the time of publication) research findings that indicated “widespread and well-documented prejudice” (p. 47) against elderly and terminally ill patients, and that suggested prejudice and avoidance behaviors were fostered in American medical schools. He also documented benefits of psychological support for dying patients and then identified and discussed eight
  • 3. © 2008/2014 by Dawn Drake 2 reasons to explain the fear that he believed could explain doctors’ behaviors toward these patients. Many of his explanations reflected spiritually related problems that he believed were at the root of the issue. Lieff (1982) did note that some medical professionals, mostly not physicians (i.e., nurses, social workers, therapists, and some physicians who find personal reward in providing elder-care), countered the norm by providing more effective services to the elderly. After discussing the relevance of the spiritual needs of the dying, Lieff (1982) concluded by positing the need for an increased professional emphasis on the “psychological and spiritual considerations” (p. 59) of the final stage of life. Critical Reflections The dominant purpose of this article seems to be to convince the reader that Western doctors (specifically, American doctors) were not prepared to support the emotional and spiritual needs of the patients who were dying, and further, that spiritual training should be included as a standard component of medical training for doctors. All of the reasons for fear that Lieff (1982) discussed reflected psychological or spiritual issues; consideration of other contributing factors was noticeably lacking. Although Lieff (1982) offered persuasive ideas to explain why doctors might fear chronically ill and terminal patients, many of his descriptions of doctors’ attitudes and experiences included neither research references nor acknowledgement that the statements were his opinions—presumably based on his experiences in the profession, but opinions, nonetheless. Examples include assertions (Lieff, 1982) that many doctors did not recognize the human potential to
  • 4. © 2008/2014 by Dawn Drake 3 transcend physical limitations and find personal fulfillment, that doctors lacked resources for finding “information about the purpose of the ending of life, and of death” (p. 55), that most doctors were not prepared to deal with the impact that religious beliefs or experiences had on the efficacy of medical treatment, and that our society had given doctors “a kind of priestly status” (p. 58). Acknowledging his comments as opinions or personal observations and then explaining his reasoning could have provided an opportunity to persuade a skeptical reader to agreement. By offering neither research findings nor personal reasoning, Lieff potentially increased the reader's resistance to his arguments. Numerous statements also seem to express Lieff's (1982) own frustration in coming to terms with death and dying, especially within American society. For example, Patients and their families generally turn to the physician for solutions to these problems, . . . The typical doctor is perhaps no better prepared to take care of his own elderly parents and grandparents . . . But they are expected magically to provide solutions (p. 55). Theorists, such as Erikson (1963) and Lidz (1976), attempt to include the termination of life as a psychological developmental stage. But what psychological development leads to death? (p. 56) In a medical system that lacks a spiritual basis for making decisions, it is not acceptable to die without a medical cause. This is just one of many ways in which the doctor is rendered helpless in a system which is structured to help him hide these feelings of helplessness (p. 58). Upon recognizing this undertone of personal frustration, the reader might question the objectivity, and therefore the validity, of the overall argument. This, in conjunction with the lack of support for many of the assertions made, undermines the potential benefit of Lieff's (1982) presentation of the issues.
  • 5. © 2008/2014 by Dawn Drake 4 Further Research Lieff (1982) supported Kastenbum’s recommendations for providing patient- oriented standards, but expressed reservations about the whether those recommendations could be successfully implemented in America. Lieff (1982) suggested that hospices, which were rare in the U.S. in 1982—only about 1,500 programs existed by 1985 (National Hospice and Palliative Care Organization, n.d.)—might provide a satisfactory model for end-of-life care. Changes have occurred in American society that have dramatically altered the circumstances that existed when Lieff (1982) wrote this article. Some pivotal ones that directly affected medical care are • in 1983, Medicare began paying for hospice care for eligible patients (von Guten & Ferris, 2002), • in 1997, Geriatric Psychiatry was approved as an official subspecialty (American Board of Psychiatry and Neurology, Inc., n.d.), • in 2006, the subspecialty of Hospice and Palliative Medicine (HPM) was approved (American Board of Medical Specialties, 2006; palliative care provides treatment to alleviate pain and symptoms without treating the underlying cause), and • according to the National Hospice and Palliative Care Organization (2007), in 2006 the number of hospice programs in the U.S. had grown to 4,500, serving an estimated 1.3 million patients, and more than one third of all deaths in the United States that year occurred in a hospice program.
  • 6. © 2008/2014 by Dawn Drake 5 These changes suggest that a significant shift has occurred, or is occurring, in the way the medical community views elderly and terminally ill patients, but they don’t tell us the source or reason for the change. The research cited by Lieff (1982) needs to be revalidated, especially in regard to whether prejudicial attitudes and avoidance behaviors are still demonstrated in medical schools and among practicing physicians, and what psychiatric treatment is provided to elderly and terminally ill patients. It would also be appropriate to look for other factors besides the fear that might contribute to those attitudes and behaviors. Lieff’s (1982) comments also raised several other issues that suggest further research opportunities. He noted that nurses, social workers, and therapists were leading the way in providing better care for the elderly. How do their ways of treating and interacting with patients differ from physicians? Do they have different attitudes about patients or perspectives on life and death? What is the source of any differences? If they learned the methods and attitudes in a formal setting, how were those alternatives taught? Are those methods transferable to physician training, and if so, has there been progress in incorporating those changes into medical schools? How do patients and their families perceive the care that the nurses and other care providers deliver in contrast to the care that is provided by physicians? Do these patients and their families communicate their feelings to others, and if so, has it effected any change in expectations in those others? How do doctors respond to these methods—are they supportive, obstructive, or neutral? What consequences do these practioners experience, and how does that affect their
  • 7. © 2008/2014 by Dawn Drake 6 motivation to continue with their methods? And, of course, how many physicians are entering the new subspecialties that are targeted to treating these patients? Lieff (1982) suggested that physicians should receive more spiritual training, based on his assessment of their fears. It would be appropriate to conduct current research to determine whether his assessments are correct in regard to today’s physicians; for example, whether doctors believe that they have a “priestly status” (Lieff, 1982, p. 58) in our society and that they are ill prepared ethically and morally “beyond obeisance to academic and guild organizations” (p. 58), whether death certificate requirements make them feel helpless, and whether they refer patients to specialists for assistance in coping with “problems of meaning and purpose” (p. 54). Research into doctors’ opinions about including spiritual orientation in medical training would be important, and if they support the idea, what methods they would consider acceptable for determining the content and delivery of that training. This article raises issues and possibilities that are rife with questions worthy of exploration. Additional examination should quickly raise research possibilities beyond those suggested above. Conclusion Lieff (1982) presented convincing research that chronically ill and terminal patients need psychological support, yet many American doctors exhibited avoidance behaviors toward them in the early 1980s. It appears, though, that Lieff’s primary goal was to persuade the reader that spiritual training should be included in American medical training. Because he focused primarily on spiritual issues,
  • 8. © 2008/2014 by Dawn Drake 7 positioned opinions as facts, and conveyed an undercurrent of frustration, the article is subject to being discounted as fallacious rather than being accepted as an objective, scholarly treatment of a legitimate professional concern. More than a quarter of a century has passed since the article was published, and in that time, significant changes have occurred in the medical field that affect how terminally ill patients are treated in the U.S. Given the growing population of the elderly and the seriousness of the concerns raised by Lieff (1982), current research into medical training practices and the need and appropriate goals for including spiritual training in medical education curricula seems both appropriate and important to ensuring that a high quality of compassionate and effective care will be available to individuals who are reaching the end of their life.
  • 9. © 2008/2014 by Dawn Drake 8 References Ages Health Services Inc. (1996). Form 10-KSB/A-1 Annual Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934. Retrieved from http://www.secinfo.com—drP9x.81v.htm American Board of Medical Specialties. (2006). News release: ABMS establishes specialty certificate in hospice and palliative medicine. Retrieved April 30, 2008, from http://www.nhpco.org/i4a/pages/index.cfm?pageid=5072 American Board of Psychiatry and Neurology, Inc. (n.d.). Initial Certification in the Subspecialty of Geriatric Psychiatry. Retrieved from http://www.abpn.com/gp.htm National Hospice and Palliative Care Organization (NHPCO). (n.d.). Growth in U.S. hospice programs: 1974 to 2006. Retrieved from http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and- figures_Nov2007.pdf National Hospice and Palliative Care Organization (NHPCO). (2007). NHPCO facts and figures: Hospice care in America. Retrieved from http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and- figures_Nov2007.pdf von Gunten, C. F., & Ferris, F. D. (2002). CAPC manual: Everything you wanted to know about establishing a palliative care program but were afraid to ask. Retrieved from http://64.85.16.230/educate/content/rationale/ushospicegrowth.html