Palliative care experts focus on comfort before death

Palliative care specialists study how to manage a patient's last months to give comfort. One expert says end-of-life consultations are just what Americans need to deal with death.

The New York Times reports on "palliative care specialists, who have made death their life's work. They study how to deliver bad news, and they do it again and again. They know secrets like who, as a rule, takes it better. They know who is more likely to suffer silently, and when is the best time to suggest a do-not-resuscitate order." This field has "become a recognized subspecialty, with fellowships, hospital departments and medical school courses aimed at managing patients' last months. It has also become a focus of attacks on plans to overhaul the nation's medical system.... Many physicians dismiss these complaints as an absurd caricature of what palliative medicine is all about."

"Still, as an aging population wrangles with how to gracefully face the certainty of death, the moral and economic questions presented by palliative care are unavoidable: How much do we want, and need, to know about the inevitable? Is the withholding of heroic treatment a blessing, a rationing of medical care or a step toward euthanasia? A third of Medicare spending goes to patients with chronic illness in their last two years of life; the elderly, who receive much of this care, are a huge political constituency. Does calling on one more team of specialists at the end of a long and final hospital stay reduce this spending, or add another cost to already bloated medical bills?" (Hartocollis, 8/19).

Meanwhile, Newsweek interviews Dr. Diane Meier, a palliative-medicine specialist at Mount Sinai Medical Center in New York and director of the Center to Advance Palliative Care, about end-of-life consultations. "Ninety percent of Americans say they would prefer to die at home, yet more than half of us die in hospitals," the magazine reports. "The 'death panel' rumors of the last few weeks have obscured some uncomfortable but important facts: everyone dies, and end-of-life care will always be a part of medicine, whether we like it or not" (Yarett, 8/19).

http://www.mountsinai.org/