National Hospice Palliative Care Month

When most people hear the term “hospice”, they immediately think of a patient on death’s door being administered strong pain medication like morphine.  Hospice aims to provide comfort care at the end of life.

But what is palliative care and how is it different than hospice?  Palliative care comes from the Latin work palliare, which means “to cloak”.  It is a term that is often associated with hospice, though it can be quite different.  Palliative care attempts to focus on relieving someone’s suffering and is appropriate for all stages of a person’s disease process (not just end of life like hospice).  The goal of this type of care is to improve the life of the patient and their family and reduce or relieve suffering.  It may include pain medication, chemotherapy or radiation.   It is not meant to speed up or prevent natural death.  Many health care workers are involved in palliative care including doctors, nurses, pharmacists, social workers and dietitians.  Studies suggest that when palliative care is implemented properly, patients experience less depression and improved quality of life.As a dietitian in the ICU, I am often frustrated by the escalating level of care for patients that are considered palliative.  Is continuing chemotherapy or using IV feedings for a prolonged period of time on patients with widespread metastatic cancer “palliative”?  Is having blood drawn daily, receiving multiple blood transfusions to stay alive and developing complications from chemo and other modalities relieving or causing suffering?  Not only do many of these therapies tax the patient, they also increase stress among health care workers and increase hospital spending.  When the care causes more damage than benefit, perhaps it is time to stop and call in hospice.  In my opinion, we spend more time passifying the family of a dying patient and not nearly enough on discussing which therapies are appropriate to discontinue at the end of someone's life.If nothing else, working in the ICU has made me more aware of what care I want and don’t want if I were suffering from a chronic, incurable illness.  If I cannot eat or swallow, please don’t put a feeding tube in me unless my condition is reversible.  I choose not to be kept alive on mechanical ventilation (life support) if I can no longer speak, walk or carry on normal activities of daily living.  I am in favor of organ donation if I am brain dead and my liver or heart would continue the life of someone else.  I would much rather America’s health care dollars go towards stem cell research or other medical treatment in preventing or curing disease than prolonging my “life”, or inevitable death.I urge you to complete a living will and clearly spell out which treatment you do or do not want.   It is your right to be heard when the time comes.