Palliative Care

What is it?

Palliative care is a form of medical treatment concentrating on reducing the severity of symptoms rather than on striving to halt the progression of disease. It is introduced when a patient's disease no longer responds to approved treatments; clinical trials are no longer an option and/or the patient is simply too sick to continue aggressive therapy. It is a shift in focus from the curative to quality of life.

The first goal of palliative care is to relieve the patient's physical pain and suffering. Secondly, palliative care addresses the psychological and spiritual needs of both the patient and her family. Palliative care involves a team of professionals creating a complete mind-body-spirit support system for end-of-life issues.

When do I stop trying?

The most important factor at this stage of your journey is the relationship between you and your doctor. Honesty and trust are paramount in a decision of this magnitude. Patients may have undergone multiple rounds of chemotherapy and their disease may have become resistant to known treatments. Patients may be experiencing severe toxicity issues from previous chemotherapy and be too sick to continue.

A patient may decide that they've had enough and are unwilling to undergo the challenges of further treatment.

Some patients may never give up - they maintain an element of disease denial and continue to pursue every available avenue.

What are some practical considerations?

According to a bioethics study on quality end-of-life care, most patients' wishes include:

• adequate pain and symptom management
• avoiding inappropriate prolongation of dying
• achieving a sense of self-control
• relieving burdens
• strengthening relationships with loved ones

Designating someone to act as your advocate is a very important consideration. That someone may need to be a friend, rather than a family member, who can be trusted to ensure that your wishes are truly respected.

Coming to terms with your mortality raises fundamental questions including:

• What do I want to do with the time I have left? Do I want to travel, do I want to take the risky treatment, is there something I need to accomplish, is there an event upcoming in my life that I really want to attend (wedding, christening, etc.)?
• Where and with whom do I want to spend my remaining time?
• Do I have relationships that I need to mend?

Dying is still living. Hopefully, throughout your journey, you will have developed the skills necessary to live and die well.

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