Thomas E. Finucane, MD
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0081.
Finucane T.; Goals of Palliative Care. Ann Intern Med. 2014;160:656. doi: 10.7326/L14-5009-6
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Published: Ann Intern Med. 2014;160(9):656.
TO THE EDITOR:
Broxterman's essay (1) describes the unexpected and wonderful recovery of a 73-year-old man who had been found unconscious. His large, expanding subdural hematoma led to partial uncal herniation. The patient was receiving propofol and fentanyl infusions to achieve standard palliative care goals (that is, “to ensure that the patient [was] comfortable and symptoms [were] well-managed”). When this therapy was discontinued and as the patient recovered, he wrote, “My throat hurts.” Later, he “showed signs of fatigue, so [the narrator] restarted low-dose fentanyl so that [the patient] could rest.” Even under the flag of palliative care, using propofol and fentanyl to ensure comfort and manage symptoms for a patient with a sore throat and using fentanyl so that a fatigued patient can rest seem oddly imprecise and disproportionate.
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