Celebrating Humane Health Care: Palliative Care Provides a Model
Fulton, M. Jane, Seely, John F., Humane Health Care International
Correspondence and reprint requests to: M. Jane Fulton, School of Natural and Health Sciences, Barry University, 11300 NE 2nd Avenue, Miami, Florida 33161.
The old saying, "Everyone wants to go to heaven, but nobody wants to die first" symbolizes our reluctance to talk about and face the inevitability of death. This reluctance adds to our distress when we, or those we love, face life-threatening illness and death. The modern hospice (palliative care) movement began with Dame Cicely Saunders in the United Kingdom in the 1950s. Her early work focussed attention on the control of pain and other symptoms in patients dying with cancer. Growing recognition of the widespread neglect of the needs of the dying in hospitals and other institutions, led to the opening of St. Christopher's Hospice in London, England in 1967.
Neglect of the dying still persists in North America, despite the growth in our knowledge and ability to control their symptoms and despite an increase in public support for the palliative-care option. During the past 12 years, Humane Medicine (now Humane Health Care International) has encouraged a broad discussion of the complex issues surrounding death and the dying process, and has helped to raise professional and public awareness of palliative care as a model of humane and compassionate care for those facing terminal illness. Since the first issue of Humane Medicine many individuals, such as Ted Keyserlingk, (1) Arthur Schafer, (2) Margaret Somerville, (3) John Dossetor et al., (4) and Abby Lynch, (5) have discussed care choices for the dying, have described the potential benefits of palliative and hospice care, and have stimulated many to think deeply about the process of dying. We believe that palliative care has much to contribute to the humanization of medical practice and that it offers a more humane end to life than assisted suicide or euthanasia.
In this paper, we describe and compare acute care, palliative care, and euthanasia as approaches to terminal illness and dying. We also advocate that both the philosophy of palliative care and its compassion for the whole person be incorporated into acute care. Finally, we predict that improved availability of palliative care to those who are dying and related support for their families will reduce the perceived need and public support for euthanasia.
The Growth of Palliative Care
Choices for the care of the dying have increased dramatically since the 1950s, when patients dying in hospitals were largely neglected on the grounds that nothing could be done to cure their disease or control their symptoms. Though neglect on these grounds persists in acute-care institutions, the options for the dying now include palliative care in hospice or other institutional settings, in the home with a mix of nursing assistance and homemaker care, and terminal care in the home with intermittent admission to institutions as needed for symptom control or caregiver relief.
Now the skills and knowledge of palliative care are brought to bear earlier in the disease process, when curative therapy is still being given. Moreover, the conditions for which palliative care is deemed appropriate have widened to include such conditions as AIDS or HIV infection, amyotrophic lateral sclerosis (ALS), and end-organ failure due to terminal liver, heart, lung, or kidney disease.
Palliative care is both a philosophy and a discipline, which consists of a defined knowledge base, skills, and attitudes as complex as any in clinical medicine. This wholistic, person-centred care requires expert knowledge of multiple drugs, their interactions and the effects of organ failure on drug metabolism, meticulous symptom management, and great skill in interpersonal communication. It recognizes that the needs of the whole person embrace physical, emotional, social, and spiritual domains. Such care requires an interdisciplinary, collaborative approach, as well as attention to teamwork and team process. …