The most basic credo of modern medicine is “first, do no harm.” Many of the treatments that we now have available, although often lifesaving, can be painful or difficult for patients and their families. We offer these treatments and encourage patients to persist because we truly believe that after all is said and done, the patient will be better off for it. Unfortunately, we are still not able to cure everyone, and some patients eventually may be faced with little or no chance of real benefit from ongoing treatments.
To continue with aggressive treatment can be physically and emotionally painful at a time when the patient would be better served by improving his or her life rather than extending it. Although these situations are difficult for doctors, patients, and their families, it is important that every-one be honest and open. Ultimately, it should always be the patient’s decision whether to continue treatment or to move to what is called palliative therapy.
Palliative therapy is designed to provide a patient with the best quality of life possible without regard to long-term cure of a terminal disease. Choosing palliative care does not mean that you have chosen no care.
Although the specific treatments that you choose to accept will be specific to your situation, most patients will still receive blood transfusions when needed, radiation treatments aimed at reducing bone pain, medications, and even surgery if it would improve bothersome symptoms. Choosing palliative care means an acceptance that your cancer is incurable, but it allows you to continue receiving certain treatments.
Palliative therapy is somewhat different from care termed “comfort measures only.” Patients who have chosen to limit their treatments to comfort measures only usually have very little time to live and will essentially receive only pain medications to keep them comfortable. They would usually not receive blood transfusions or dialysis, undergo surgery, and the like.
Dealing with my mother’s death was difficult. She had always been very clear that she did not want to be on a ventilator or feeding tubes, that she wanted to maintain her dignity if the outcome was clear. When she was doing well, it seemed like it would be easy to follow her wishes. But they never come to you and say clearly that “this is the moment” to let her go.
There’s always another treatment, another doctor, another something. It was easy to make the decision to provide palliative care only because mom could still speak for herself. The “comfort measures only” decision placed much more responsibility on the family. After long discussions with her doctors, we finally agreed that keeping her comfortable and allowing her to rest peacefully would be the best way to honor her life and her wishes.
It helped that we had all been able to talk openly with my mother about the end while she was well, and I know it was what she would have wanted, but it was still the hardest decision I’ve ever had to make. (M. D., 59 years old)