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Palliative Care: Dealing With End-of-Life Issues, Med Times Copyright, All Rights Reserved, 2004-2005


Palliative Care is a unique form of health care developed to address the needs of those with terminal illness. This specialty focuses on the needs of the patient and the family when a cure for a life-threatening illness such as cancer or AIDS is no longer available. A primary goal of palliative care is to improve the quality of a person’s life as death approaches and to help patients and their families move toward this reality with comfort, reassurance and strength. Palliative Care is not focused on death, rather it is about specialized care for the living.

The number of people with terminal illness is growing rapidly. In developed countries, the aging of the population is expected to lead to a significant increase in deaths from cancer, cardiac, respiratory and other chronic illnesses. The World Health Organization (WHO) projects that by the year 2015, 15 million people will develop cancer. This is in contrast to 9 million people in 1985. The WHO also estimates that by the year 2000, there could be as many as 110 million people infected with the AIDS virus.

These statistics paint an alarming picture - one of physical and psychological distress caused by a system that is not ready to accommodate this growth in the number of people with terminal illnesses. Most studies confirm that our present health care system is failing to meet the needs of the dying and that many are experiencing needless suffering. Yet, field trials demonstrate that even simple initiatives in palliative care can help lessen this unnecessary burden of pain and suffering.

The cost of dying to our society is also immense. In developed countries, the care delivered to the terminally ill during the last few months of life represents the largest portion of their total lifetime health care costs. However, much of this cost is a consequence of initiating futile treatments - treatments that arise from our misplaced and often frantic need to prolong life even in the face of irreversible illness. Palliative care focuses on realistic goals, lowering costs significantly.

The health care system in is undergoing fundamental and rapid change as the public considers improving the care of the dying to be a high priority. Government faces greater demands for the involvement and commitment to proper care of the terminally ill.

Palliative care is critical if our society is to successfully shift its focus toward the community. Today, many terminally ill patients and their families want to be free from the frenzy of the acute care hospital, preferring instead the personalized setting of a hospice or palliative care unit. Yet, the terminally ill are a vulnerable population that cannot defend or speak for themselves during this time of crisis and upheaval in their lives.

The societal debates on euthanasia and assisted suicide demonstrate public awareness of the importance of these issues. The controversy surrounding euthanasia also reflects fear and mistrust at both the individual and societal level. The fear of death and of the process of dying is a powerful psychological force. It can drive both patient decision-making and legislative changes.

Palliative care focuses on controlling suffering and maximizing quality of remaining life. It is founded on highly developed clinical expertise in pain and symptom management, timely and responsive patient-centered communications, and interdisciplinary teamwork. This type of care also calls for justice through access to palliative care for all those who are dying. Enhancement of services, overcoming barriers to referral, and increased training and research in the control of suffering are the appropriate responses to the present crisis.