Palliative Care Textbooks Come of Age

At last, good care of the dying is on the American agenda. One can hardly pick up a newspaper, magazine, or medical journal without finding an article devoted to some aspect of end-of-life care. Many major medical organizations have joined the lament-sounded for the past 25 years by the hospice movement-that care of the dying is woefully inadequate, and they have challenged us to improve our palliative care practices [1-8]. Hospice programs have shown us what good care looks like, but these model programs have largely been restricted to patients with cancer who are expected to live for 6 months or less; these patients are usually in their last weeks of life, accept that they are dying, agree to forego “aggressive” treatment, and have caregivers at home.

New systems of care are needed for severely ill patients with less certain prognoses, for those who desire to continue disease-oriented treatments, and for those who lack access because of insurance barriers or absence of support at home [9]. Such new systems would extend palliative care to more patients with cancer as well as to dying persons with dementia, congestive heart failure, chronic pulmonary diseases, and end-stage liver disease. Indeed, pain and symptom management and psychosocial and spiritual support are relevant to all seriously ill patients, regardless of whether they choose to receive only comfort measures or wish to energetically fight their underlying diseases. Even in the intensive care unit or emergency ward, patients and their families may benefit from hospice-like services.

Most mainstream medical articles written about end-of-life care address the inadequacies of current systems of education and service delivery, management of cancer pain, or “cutting edge” ethical issues surrounding physician-assisted death. Too often, physical pain is equated with human suffering; this falsely suggests that if we close the gap …