End-of-life Care Just as Important as Cures

Being able to have a peaceful death with dignity can be among the positive milestones in the cycle of life.

Studies show that up to 88 percent of people in our country want to die at home surrounded by their loved ones. Yet the reality is that only about one in four people have a peaceful death at home or in a hospice setting.

This incongruity happens because, at the time of grave illness, both physicians and patients become reluctant to accept death and instead focus on our high-tech health care system. We reject death whenever there's still a chance of reversibility or "cure." As a result, there's often little or no time to transition a patient home when death becomes inevitable.

Nursing professionals typically have provided direct support in the end-of-life process. They do an excellent job, but in our medical system, care usually is determined by physicians. So, it's important that our doctors, not just patients, learn more about hospice and palliative medicine, the medical specialty that deals with helping patients at the end of life.

A doctor sometimes fails to recognize when attempts to cure come at the expense of a death that is painful--physically, emotionally or spiritually--because most physicians are trained to make you better.

I often tell a story about why certain specialists in medicine forget about end-of-life options. Let's say you were building a house and you ask a carpenter and a mason what materials should be used. One would expect each to genuinely and compassionately recommend that which they know best. So it is with physicians, who also know their own area of medicine.

Our health care system is well equipped with accepting patients into curative care, but is not adept at graduating them into palliative care. Doctors with an interest in palliative care are teaching medical students, colleagues and patients that end-of-life care can be both curative and palliative. For instance, a patient may opt to have some procedures, but not others. Physicians can learn more about how to treat pain and non-pain symptoms in a dying patient and provide spiritual and emotional support.

If your specialist does not talk to you about palliative care at the appropriate time, don't be afraid to raise the issue for yourself or others. Doing so doesn't mean the health care professional will neglect you or not save your life if that still is possible. Instead, you will give yourself the opportunity to have comfort and care truly throughout your entire life.

Last Reviewed 2005

Source: Richard Dobyns, M.D.
University of Iowa
Department of Family Medicine

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.