What is the goal of palliative care?

Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.

As we get older it  becomes important to have a family discussion about what to do if you’re incapacitated in the hospital with not much hope of recovery. Advanced directives such as Do Not Resuscitate (DNR), a Living Will, or Durable Power of Attorney are important decisions to make. Providers are trained to go to heroic efforts to keep patients alive even when all hope is gone.  This often results in severe pain and suffering. There have been many horror stories of the pain and suffering from brittle ribs broken during CPR.

I bet you didn’t know that less than one in seven CPR recipients live to leave the hospital (don’t feel bad, many doctors don’t know this). Other studies show that few elderly patients or patients with cancer live to leave the hospital after CPR. Despite the fact that CPR was developed to resuscitate patients in cardiac arrest, CPR is mandatory to rescue the terminally and critically ill, unless there is an advanced DNR directive. One in five people die in intensive care with the last few months of life being expensive, painful, and futile exercises in medical care.

Thanks to palliative care medicine, doctors as well as medical students are being taught the importance of saying the ”D”-word.  Palliative (or comfort) care differs from hospice care in that it can happen along with aggressive life-sustaining treatments. Palliative care teams of doctors,  nurses, and social workers provide patients and families with the information they need to make painful choices, including decisions to avoid overly invasive care.  What patients and their families want is for doctors to be clearer and more realistic about what’s going on.

The aim of palliative care is for patients to live as well as long as possible while preparing them and their families for death.

So, please talk with your family and make arrangements so you can die peacefully and with the dignity you deserve.

Jeffrey I. Kreisberg served on the faculty the University of Texas Health Science Center at San Antonio where he was a Professor of Pathology, Medicine, Surgery, Urology, and Molecular Medicine.  He is the author of Taking Control of Your Healthcare. He blogs at Taking Control of Your Healthcare and can be reached on Twitter @kreisberg.

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