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Palliative Care is Humane End-of-Life

Author: Helen Dennis, Specialist on Aging

Question: My father recently died at the age of 87 in a hospital in the Midwest. His condition was terminal, which, despite his age, was very difficult to accept. After much family discussion, we requested palliative care, which his physician refused. His doctor said he was bound by the Hippocratic Oath. We were distraught. We finally found the appropriate care (which my father supported) in another part of the hospital. I felt we went through unnecessary anguish. Can you write about palliative care so others won’t have to go through the experience we had? Many thanks.

What a terrible experience. Let’s begin this emotional topic with a brief – non-emotional – discussion of palliative care.

The word “palliative” is derived from Latin, meaning “to cloak” or “to shield.”  The Oxford English Dictionary defines it as “alleviating symptoms without affecting a cure.”

Another definition is offered by the World Health Organization (WHO): “The active total care of patients whose disease is not responsive to curative treatment. … It (also) is applicable in the early course of illness, in conjunction with other therapies that are intended to prolong life such as chemotherapy and radiation.”

The goal is to achieve the best qualify of life for patients and their families.

Although palliative care is associated with end of life, that is not always the case. The following are characteristics of palliative care as described by WHO.

Palliative care:

  • Provides relief from pain and other distressing symptoms.
  • Regards dying as a normal process.
  • Is not intended to hasten or postpone death.
  • Offers support to help patients live as actively as possible before death.
  • Provides a support system to help families cope during the illness and assists in family bereavement.
  • Uses a team approach to address needs of the patient and family, offering counseling if indicated.
  • Enhances the quality of life and sometimes may have a positive influence on the illness.
  • Can be used in the early stages of an illness with other therapies that prolong life.

Palliative care is an area of research. Recently, the American Cancer Society and the National Palliative Care Research Center awarded $1.8 million in research grants to 12 institutions, to conduct studies that reduce the suffering of seriously ill patients and their family caregivers. UCLA is one of the recipients.

A new acronym has emerged: QOD, or quality of death. The Economist Intelligence Unit presented a paper commissioned by the Singapore-based Lien Foundation. It ranked the QOD of 40 countries. Here’s a quick summary:

The United Kingdom ranked highest in the QOD index. It was considered “far from perfect” but topped the quality of end-of-life category, which included “public awareness, training availability, access to painkillers and doctor-patient transparency.” It also was a leader in hospice care.

After the U.K. were Australia, New Zealand, Ireland, Belgium, Austria, the Netherlands, Germany, and then a tie between Canada and the U.S. The U.S. ranked seventh in quality of end-of-life care, eighth in availability of end-of-life care, ninth in basic end-of-life health care environment, and 31st in cost of end-of-life care.

Hippocrates, a Greek physician born in 460 B.C. and the founder of modern medicine, stated that physicians are “to do no harm.” There have been many interpretations of this phrase.

In general, palliative care is not considered “harmful.” Such care is central to the services of Hospice, which focus on caring, not curing.

In most cases, care is provided in the patient’s home. It also is offered in free-standing hospice centers, hospitals, nursing homes and other long-term-care facilities. The care team usually is composed of doctors, nurses, home health aides, spiritual counselors, social workers, volunteers and bereavement counselors.

Thank you for your important question. Hopefully, others will not have to go through the experience of interpreting the meaning of “do no harm” in dealing with end of life of a loved one.

Sending best wishes to you – with good memories of your father.

Copyright 2010 Helen Dennis. All rights reserved.

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