IF I HAD TO CHOOSE BETWEEN HOSPICE CARE AND PALLIATIVE CARE…!
by Father Angelo
The question has been asked: “What can be done, vis a vis the growing acceptance and practice of palliative care in America?” I do not presume to know the best answer to this question, but I will give my personal insights and opinions, and my response must be treated as such.
I am someone who has worked on an “interdisciplinary team,” with a palliative care physician and his aides as part of that team, I do not pretend to be a physician or lawyer or legislator by any means. In answering this question, I will simply state what I would want for myself or one of my loved ones.
First of all, it is important to recognize that there is a great difference between hospice care and palliative care. In my dozen years of working closely with dying patients, I have come to the personal conclusion that hospice teams do not have a negative agenda for patients under their care. If a patient seems to be terminal or in his/her last weeks or days, there is a general attitude of wanting the patient to live and die as comfortably as possible. I have never personally witnessed any “agenda” by hospice teams of trying to expedite the inevitable.
In my one year of working daily on an interdisciplinary team, which included a palliative team with palliative physician, I soon became aware that there was a strong agenda of pushing for a quicker death. In pushing for a quicker death, there was always the emphasis on “comfort care” and “letting nature take its course.” By “letting nature take its course,” what was meant was really this:
1- no more treatments to prevent infections;
2- removal of nutrition and hydration;
3- no more treatments that had the goal of finding a cure or were conducive to promoting the patients overall health. The primary medical treatment used by the palliative team I worked with was the administration of pain killers. Palliative teams which my chaplain friends at other hospitals have worked with have told me that the primary medical treatment they observed was the administration of pain killers.
Many was the time that a palliative physician or aid said something to me like: “The family chose to keep the patient on nutrition and hydration. They don’t realize that one ounce of nutrition can unnecessarily prolong life another couple of weeks. If only families would be more informed, and realize that all this money is being spent for prolongation of miserable existence and not life, they would withhold this kind of treatment and just let nature take its course.”
In sum, I have told my family members, and my medical power of attorney, to forbid a palliative care team from treating me. My general experience has been that primary doctors will make sure that a patient is kept as comfortable as possible, even before death, without a strong agenda of pushing for expedited death. If more patients keep palliative teams away, then more and more palliative teams and their hospitals will lose business and then seek a more moral way to practice medicine. This is the solution I have chosen for myself, I do not pretend to know that this is the best solution, it is only my solution for myself and those who are nearest and dearest to me.