Improving Palliative Care

IN RESPONSE:

We agree with Dr. Fitzgerald's concerns about the hazards of medicalization of the dying process and the risk that important experiences and opportunities for patients and their loved ones may be compromised by an almost exclusive focus on end-of-life care as a series of medical problems requiring resolution [1]. To the contrary, the patient and family have the central roles in the process and do the major emotional, existential, and spiritual work of the last phase of life. Nevertheless, most dying patients have distressing physical and psychological symptoms [2, 3] that can be effectively alleviated by appropriate medical intervention. Thus, medical care has a critical role to play in addressing these needs to improve quality of life so that patient and family have the opportunity to focus on the more important emotional, existential, and spiritual issues. However, and often with the best intentions, medical professionals actually frustrate or inhibit this critical work by filling the precious time remaining with diagnostic tests, experimental or “last-ditch” treatments of extremely low yield, and creation of false hopes that pose very real costs and losses to our patients, who cannot get this time back later. An important step in correcting this imbalance is the education of medical professionals on both the value of a peaceful death and the possibility of achieving one. The suggestions that we made in our article involving changes in medical education, attitudes, and organizational characteristics of the health care industry are intended to promote this goal.