My congratulations to the New York State legislature for passing a recent bill promoting patient / family education regarding palliative care. Shame on the NY State Medical Society for resisting it.
Today's article in the NY Times by Jane Brody http://www.nytimes.com/2010/08/24/health/24brod.html?_r=1&ref=science is worthy of further discussion.
Palliative care, end of life care, makes perfect sense. The Resistance of fellow physicians is disturbing and deplorable. We should be at the front lines in the debate on offering compassionate caring. More than the public, we should be aware that much end of life treatments are not only ineffective, they produce more suffering.
This article references another from the New England Journal of Medicine which demonstrated that palliative care in addition to standard cancer therapy provided not only better quality of life at end of life but actually prolonged life by three months. Presumably this was of a "higher quality" with less depression and pain.
I am not particularly a supporter of government mandated health care reform. I fear the imposition of "standards" on my profession as much as the next physician. But when my own profession continues to treat those who are in the final stages of life as if they will recover or life better, than perhaps we need outside intervention to bring back some sanity.
As I have written before, just because we CAN offer therapy does not mean we SHOULD be doing so. The patient as a whole individual with not only physical but emotional and spiritual needs to be evaluated.
End of life issues need to be openly and actively discussed. These are societal and ethical as well as medical issues. They are clearly difficult to resolve and we must always be sensitive to the needs of particular patients and their families. Government mandates should not replace guidelines.
Let's finally face the finality of death from a position of doing what is best for that individual. And often what is best is comfort care.