For many reasons, few of us like to reflect on our own mortality or the circumstances that may accompany our death.
But the fact of the matter, of course, is that each of us will die some day, and there are some important things that we can think about and plan for, which may enhance the dignity of the dying process.
November is National Hospice and Palliative Care Month. Like many such observances, the goal is to raise awareness about a topic with which many Americans are unfamiliar.
The majority of the leading causes of death in America are chronic diseases, ranging from cardiovascular disease and cancer to dementia, chronic lung disease and chronic kidney disease. Therefore, it is not unusual for a long and gradual decline to precede the terminal stage of disease and ultimate death.
Complications of chronic disease may impact quality of life. It is not unusual for both the disease itself and associated medical interventions to lead to suffering. Modern medicine has created for us a paradox insomuch as we have developed advanced technologies to address serious disease but which may afford little hope of cure and which may enhance suffering or even accelerate death.
Yet modern medicine has also evolved to provide interventions designed to reduce suffering, enhance independence, empower patients with a renewed sense of control and dignify the dying process. Our humanity dictates that these goals are at least as important as prolonging life.
For those suffering from a potentially terminal illness, palliative care and hospice offer a continuum of options designed to address these noble goals.
Palliative care refers to care provided to patients whose purpose is to relieve or reduce the symptoms of disease and enhance quality of life. Anyone with a serious illness, regardless of life expectancy, can receive palliative care. This includes people who face a terminal diagnosis but wish to pursue further treatment of their disease.
Meanwhile, hospice is care provided to a patient diagnosed by his or her physician with a terminal illness, with a life expectancy of less than 6 months. The goal of hospice care is not to treat nor cure the underlying disease but rather to support the patient and their family through all stages of the disease and the dying process.
Typically, hospice care is provided in the patient’s own home, with the support of a multidisciplinary hospice team whose goal is to address the physical, psychological and spiritual needs of the dying patient and to support the patient’s family both before and after their death.
Modern medicine is beginning to realize that advanced but often futile efforts to treat a terminal disease need to give way to efforts to reduce suffering, improve quality of life and enhance the dignity of the dying patient.
In his recent best-selling book, Being Mortal, Dr. Atule Gawande offers a fascinating account of where we have been, where we are now and where we need to go in our common journey to better support seriously ill and dying patients. I strongly recommend that you read it.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.
