Dr. Jeff Kane: Understanding palliation
Many years ago my aunt was dying from cancer. Her docs did “everything,” they said, including procedures I now recognize as predictably futile. Hardly any effort was made to inform her or us, her family, of what was happening, let alone provide any comfort. I can’t remember the C word even being spoken.
The term “palliative care” wasn’t yet in common use. (Sometimes palliation is called “comfort care.”) Only in the past few decades have we in Western healthcare realized that when someone is irreversibly sick and probably dying, we can at least ease their pain and make them more comfortable. “Palliative” comes from the Latin palliatus, a large cloak of a kind worn by ancient philosophers. That image suggests protection conferred by wisdom.
I’m for palliation for everyone, dying or not. After all, what patient wouldn’t appreciate symptom control and comfort? I’m not the only one who thinks that way. Palliation has slowly progressed upstream, to many patients who aren’t dying but suffer chronic illnesses. We can’t cure them, but we can ease their journey. I fantasize that palliation will one day extend all the way to those who aren’t even sick. Is it unreasonable to hope we can take better care of one another in daily life?
Though palliation is available these days, it comes too late to too many. Hospices around the country, for example, lament that dying people are referred to them with insufficient time to create effective regimens or bond with hospice workers. Why this crucial but common delay?
You’re eligible for hospice care when your physician certifies that you’ll likely die within six months. (Of course, some patients outlive that prediction, and “graduate” from hospice.) Third parties, including Medicare, pay for hospice services only when that’s the exclusive intervention. In other words, you can’t receive treatment that’s hopefully curative while you’re in hospice. The decision to enter hospice, then, means relinquishing the thought of recovering.
Understandably, hardly anyone looks forward to that crossroad. Patients and their families aren’t happy to hear the H word, as it effectively dashes hope for survival. And for their part, many docs are uncomfortable having the requisite intimate conversation. Some docs view hospice referral as an admission of medical failure. All parties, then, can inadvertently conspire to avoid hospice until The Reaper is pounding on the door.
At least we’re beginning to use words that were formerly taboo. And now there are organizations, such as our local Full Circle Living and Dying Collective, that can help us learn and speak about dying so we can face it more wisely.
Jeff Kane is a physician and writer in Nevada City.
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