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The Healing Impact of Palliative Care Gerontology

by Sallie Guthrie, RN

  Palliative care, the phrase associated with terminal illness and death, the choice when all hope is gone. Physicians and nurses often treat this option of care with distaste and suspicion, as if palliative care is the same as an execution order. The reality is palliative care is a philosophy and treatment to give an improved quality of life to those near the end of life and those with life-limiting conditions. Our society is removed from the natural process of death; it is feared, a foe to be beaten by technology for if a patient dies it is because medicine failed. So the question remains, is death and dying unnatural, do we stop treatment and abandon patients because we can’t cure them? No, it is time to understand and incorporate the truth and value of palliative care into our healthcare and treatment of patients. It is vital that healthcare professionals are educated about what palliative care can do for this increasing group of patients.

The Healing Impact of Palliative Care 

  “America is in a state of crisis regarding the manner in which we care for people who are dying. Study after study documents that medical care for the dying is poorly planned and frequently ignores the treatment preferences of the patient and family. Pain is a commonly under-treated -- or not even addressed -- even within our most prestigious teaching institutions. Too often, and with no mal-intent on the part of the doctors or nurses, medical treatment directed at prolonging the patient's life ends up contributing to their pain, isolation, and suffering. As if all that were not bad enough, the current "non-system" of American health care routinely pauperizes people for being seriously ill and not dying quickly enough! Added to the worries of illness, patients worry that in continuing to live they will consume their life's savings and then bankrupt their family; and sometimes they are right. Too many American families are shaken with financial devastation heaped on top of the emotional grief of losing a member. Suffering among the dying in America is pervasive, and so much of it is unnecessary.” (Byock 1997)

  Ira Byock is a physician who is best-known for developing the concept of palliative and hospice standards of care. His personal experience with his father’s terminal illness allowed him the opportunity to become intimately familiar with the needs of dying patients. The above quote is an accurate depiction of end of life care in Western medicine and culture. As the patient population ages, there is a greater need for treatment options for life-limiting conditions and end of life care other than giving up. Palliative care is the best option to meet the needs of these patients and their families.

  It is essential to define what palliative care is and expose misleading concepts about it. Most importantly, palliative care is not physician assisted suicide. Ira Byock says it best, “Approaching the problem of suffering among the dying through the lens of assisted-suicide is like looking through the wrong end of binoculars; it narrows and distorts the view. My focus is in reducing the conditions that make PAS seem an attractive alternative to patients facing the prospect of living with an incurable illness and to society struggling to care for the dying. Success will not come with making assisted suicide and euthanasia legal, but rather with making them unnecessary. As a doctor my commitment is to do everything possible -- and anything that is necessary -- to alleviate a person's suffering. In the very rare situations in which physical distress is extreme it is always possible to provide comfort through sedation.
The difference between what I do and euthanasia is that palliative care does whatever is necessary to alleviate the suffering while euthanasia is focused on eliminating the sufferer. Those among us who think we would want physician-assisted suicide if we were sick, should ask ourselves whether that is also what we would want for our lover or sister or child who was incurably ill. Would we want them to die quickly, so that they would not become a burden to us? If not, we need to look deeply into what "success" would look like in this time of living we call dying.” (Byock 1997)

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