A cliche excessively used by physicians relates to “DEEMING patients palliative”. To “deem” is to consider, hold an opinion, believe, think or regard. A classic example of medical paternalism occurs when physicians “deem” a particular patient as being “palliative”. This expression is not only vague, confounding, and euphemistic, but is also the antithesis of a truly patient-centered approach to healthcare. A more precise statement would begin with expressions about the terminal/incurable nature of a given disease, its natural history, prognosis, and the lack of response to disease modulating therapies. When patients are given this information in an understandable, gentle, and sensitive fashion they are the ones who must decide whether they wish to proceed with potentially life-prolonging treatments (AAMM) for the balance of their lives, or elect for a completely palliative approach (CPM) that focuses on maximizing comfort, dignity, quality of life, and quality of death. Thus, the patient must “DEEM” themselves palliative NOT the physician. Physicians must strive to clarify the language they use when dealing with terminally ill patients. Finally, the term “Palliative” should NOT be used as an adjective to describe a patient, rather, only as an adjective to describe the philosophy (goals, ideology) of care.



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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