End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Palliative care

When Prolonging Death Seems Worse Than Death

October 9, 2012

Many of us think of death as the worst possible outcome for a terminally ill patient, but Judith Schwarz disagrees.

Schwarz, a patient supporter at the nonprofit Compassion & Choices, says prolonging death can be a far worse fate. For many patients, good palliative or hospice care can alleviate suffering, yet “a small but significant proportion of dying patients suffer intolerably,” Schwarz says.

Based in the New York area, Compassion & Choices is an organization that helps terminally ill patients and their families make informed and thoughtful end-of-life decisions to hasten a patient’s death. These decisions are not made impulsively, Schwarz tells Fresh Air‘s Terry Gross. “Nobody makes this choice unless the burdens of living have so consistently, day after day, outweighed all benefit.” More

Bringing Palliative Care Into the Conversation

by Dana Sitar
Seven Ponds
October 4, 2012

California State University is tackling a shortage in palliative care workers by launching the first statewide educational and workforce development initiative dedicated specifically to palliative care. With an aging population and an increase in the number of people living with serious illness, health care systems are facing the challenge of providing the care our population needs, and the CSU Institute for Palliative Care will help overcome that challenge.

“Our aging society requires a qualified palliative care workforce that can support people’s desire for quality of life, independence, and choice and control in their health care decisions,” said Joseph Prevratil, CEO and President of Archstone Foundation, which provided initial grant funding for the Institute, along with California HealthCare Foundation.

The CSU Institute for Palliative Care at CSU-San Marcos will offer palliative care training for professionals, and it will educate the public about the value of palliative care and how to access it. This public awareness will be invaluable to those who would benefit from palliative care but know so little about it. More

Do Seniors Turn to the Right Places at End of Life?

by Andrew Seaman
Chicago Tribune
October 1, 2012

A new study says almost one third of Medicare’s beneficiaries use the program to pay for end-of-life care at nursing homes, which may not be equipped to treat or prevent pain and suffering.

Those palliative care services are usually associated with hospice care, while nursing homes are typically for rehabilitation and long-term care.

The study’s researchers, who published their findings in the Archives of Internal Medicine on Monday, say the findings suggest that palliative or hospice care should be incorporated into Medicare’s nursing home benefits.

“Often our focus on these patients is trying to keep them functional or independent for as long as we can. What we may be overlooking is that they are on an end-of-life trajectory,” said Dr. Katherine Aragon, the study’s lead author from Lawrence General Hospital in Massachusetts. More

The Hospice Option

By Susan Canfora
The Daily Times
September 15, 2012

Talking about death is difficult.

Even for an oncologist, telling a patient treatment isn’t working, they most likely aren’t going to be cured and it’s time to think about a different kind of care is grueling.

“It’s a very hard conversation to have,” said Dr. David Cowall, medical director of Coastal Hospice in Salisbury, shaking his head and recalling spending a minute alone in his office to gather his thoughts before having that talk with patients.

“If we’re not going to cure them, there comes a time to stop treatments and look at comfort and care. Some patients bite your head off when you tell them that. Some tell you off and some go somewhere else,” Cowall said.

Interested in determining if patients are better off continuing traditional medical care or going into hospice, where symptoms are managed, Cowall co-authored the paper “End-of-Life Care at a Community Cancer Center.” It was published in the June 2012 issue of the Journal of Oncology Practice. More

Poor Pain Control for Cancer Patients

By Pauline W. Chen, MD
The New York Times
September 20, 2012

Recounting her father’s struggle with cancer was difficult for the young woman, even several years after his death. He’d endured first surgery and then chemotherapy and radiation, she told me, and the cancer had gone into remission. He was thrilled, but the aggressive treatment left him with chronic, debilitating pain. Once active, he struggled to get around in his own home.

“It wasn’t the cancer that got him,” the daughter said. “It was the pain.”

Her father had turned to all of his doctors, with little relief. His surgeon had looked at his operative wounds, pronounced them well healed, then stated that they were in no way responsible for his disability. Both his cancer doctor and his radiation doctor congratulated him on being in remission but then declined to prescribe pain medications since they were no longer treating him and couldn’t provide ongoing follow-up and dosing guidance. His primary care doctor listened intently to his descriptions of his limitations, but then prescribed only small amounts of pain meds that offered fleeting relief at best.

“I’ll never forget what my father had to go through,” she said, weeping. “I wouldn’t wish this on anyone.”

I wish I could have reassured her that her father’s case was unusual. Sadly, according to a new study in The Journal of Clinical Oncology, a significant percentage of cancer patients continue to suffer from pain as her father did. More