Palliative Care = “Glass half-full NOT Glass half-empty”

I happened to inadvertently eavesdrop on one of my colleagues today during their efforts to explain the nature of palliative care to a family member of a clearly terminally ill patient. The young doctor involved equated palliative care to “doing nothing” by using  the following list of negatives to describe it:

  • NO CPR
  • NO mechanical ventilation
  • No chemotherapy
  • No radiotherapy
  • No feeding tubes
  • No IV fluids
  • No antibiotics
  • No blood transfusions
  • No dialysis
  • No anticoagulants

Sadly, there was no discussion around clinical context, natural history of disease, prognosis, nor, any inquiry about the patient’s wishes, preferences, and values. Moreover, there was no discussion about the likelehood of more net benefit versus burden of the above listed active/aggressive interventions (individually or collectively) in the context of a patient with advanced illness with a low and falling level of performance status.

No surprise-The POA declined a conservative palliative mode of care in favour of continuing on with all interventions despite their obvious futility. A greater tragedy rests with the fact that there was no mention about measures to ensure the patient’s comfort, dignity, and QOL.

In summary, when counseling patients and family members about palliative care we should emphasize the positive aspects, ie, quality pain and symptom management aimed at maximizing comfort, dignity, and QOL. The only negative that should be used to describe palliative care is that it involves NO FUTILITY. Descibed in this manner, palliative care reflects on the glass being “half-full” rather than “half-empty”.


About drvincentmaida

Consultant in Palliative Medicine & Wound Management, Assistant Professor, University of Toronto & McMaster University, Researcher & Author.
This entry was posted in Bioethics, Distributive Justice, Palliative Medicine, Promoting PCC & PE. Bookmark the permalink.

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