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May 17, 2012

I have noticed a troubling trend in recent years, talking about end of life care with my friends, colleagues, and students. Some have the mistaken notion that medical care of terminal patients is designed to hasten death rather than lessen suffering. A woman friend has suffered from guilt since her terminally-ill mother passed away. She said to me: “They convinced me to put my mother in hospice care. Sure enough, a week later she was dead. I should have known better!” Another friend recently told me: “Yeah, once doctors decide a patient is terminal, they make sure they die as soon as possible.”

Apparently, these sentiments are more common than I thought. A recent study in the Journal of Palliative Medicine confirms that many members of the public have negative views of hospice and palliative care. Consider the following commentary from an American Medical Association website:

Three decades after hospice emerged as the standard of care for terminally ill patients, the end-of-life treatments that palliative medicine physicians provide are frequently referred to as murder, euthanasia and killing.

More than half of hospice and palliative medicine physicians say patients, family members and even other health professionals have used those terms to describe care they recommended or implemented within the last five years, according to a nationwide survey of 663 palliative care doctors in the March Journal of Palliative Medicine.

In fact, however, the hospice movement is one of the best things to happen in the modern world of medicine. As medical care has become more technological and sophisticated, it is possible to prolong the quantity of life at greater and greater cost to its quality. Rather than allow patients to pass away peacefully, the technological imperative seems to demand that they die in an impersonal ICU bed surrounded by machines, and with a tube in every bodily orifice. But compassionate medical care does not require that we prolong the dying process of the terminally ill.

Back when I was a resident in general surgery, it was not uncommon for me to observe my medical professors simply ignore the terminally ill on their rounds. Sometimes, I was the only physician to actually visit a dying patient during my work day, when I would draw a blood sample or perform a minor procedure. Today, the good news is that hospice and palliative (non-curative) care are recognized as medical specialties in their own right. No longer do physicians ignore the dying; the goal of hospice is to control pain and suffering at the end of life, to give dying patients and their families the help they need in these trying circumstances.

One of my former mentors once once told me: “At the end of life, patients need two things: comfort and company.” Dying patients need relief of symptoms and our presence. It seems to me that this is a wonderful way to honor our Heavenly Father, Who is the Author of life. Hospice care and palliative medicine are loving, compassionate, and effective means to encourage patients as they prepare to come face to face with the Eternal.

Full Online Commentary in American Medical News

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