Palliative care: intensive caring when cure isn’t likely
The word “palliative” may seem an odd word to use in medicine, as the dictionary defines palliate as “to relieve or lessen without curing.” Yet, isn’t it the purpose of a physician to fix and to cure? Modern medical technology often excels at providing diagnoses and treatment possibilities, but of itself, it doesn’t provide the necessary conversations when ailments prove incurable or refractory to treatment. Palliative care provides ways to care even when cure is not possible.
The Center to Advance Palliative Care defines palliative care and the medical sub-specialty of palliative medicine as “specialized medical care for people living with serious illness…to improve quality of life for both the patient and the family.” Palliative care can be helpful and appropriate at any age, in any serious illness stage, and works to provide relief from stress, in whatever form it takes. It is team-based, often with representation from medicine, nursing, social work, and chaplaincy, because serious illness affects one physically, emotionally, mentally and spiritually. Palliative care teams can be found in hospitals, clinics, or embedded in other subspecialty practices, like oncology. There is palliative care for adults, for children, even perinatally, helping parents cope when their pre-born baby is found with serious diagnosis during pregnancy.
Many people possess misconceptions regarding palliative care. Some think palliative care means “giving up” when it actually adds an additional layer of support. Patients can continue with all their other medical care, like dialysis, chemotherapy, and hospital visits. Others believe palliative care is synonymous with hospice care, but hospice is a small subset within palliative care. Both focus on comfort and living the best life possible despite serious illness. Hospice is most appropriate when care and hospitalization directed at the disease are more burdensome than beneficial. With hospice, the focus is patient comfort, most often in the familiarity of the home, surrounded by loved ones. Patients can continue medications providing symptom-management and comfort. Hospice care, when consistent with patient goals, can be a very peaceful experience for patients and families.
It is also important to emphasize that hospice and palliative care should never do anything to prematurely hasten death. The field is created as the antidote to the suffering that may cause one to seek physician-assisted suicide. As Dame Cicely Saunders, the founder of the hospice movement, said to patients: “You matter because you are, and you matter to the last moment of your life. We will do all we can, not only to help you die peacefully, but also to live until you die.”
The word “palliative” derives from the Latin pallium, meaning “to cloak.” Cloaking patients and families with support and symptom management encourages living the best life possible despite chronic or incurable illness. Studies show that people live longer – and better – with palliative care than without. Palliative care physicians witness a beautiful awe caring for patients in intense and intimate times. They are like leaves in autumn, which are most lovely before they fall, because the autumn in physical life can be a true springtime for the soul.
NATALIE RODDEN runs the palliative medicine consultation service at St. Anthony North Health Campus in the Denver area. She also serves as co-chair of her hospital’s ethics committee and travels nationally providing education and advocacy for authentically Catholic end-of-life care and against physician-assisted suicide.