A good death is possible whether we choose aggressive treatment or comfort care.  It is a team effort of patient, family and health care professionals and requires careful open communication.

The time at the end of life is different for each person. Each individual has unique needs for information and support and the medical professionals involved need to be aligned with your goals.  This includes frank discussions to help identify goals and how they might change as your condition progresses and to outline what will be needed for your care.  Your care team may include doctors, nurses, pain management specialists, hospice and home health liaisons, social worker case managers, and a pastoral caregiver.
It's possible to continue curative treatment while also receiving comfort care.  This type of care is called palliative care and it is different from hospice care.  While hospice care usually requires that patients give up curative treatments, palliative care does not. 
In fact, palliative care is valuable at any time during a serious illness.  Patients can continue to fight their disease, while palliative care focuses on improving their quality of life.

Palliative care services for the seriously ill, their caregivers, families, and loved ones include:

• Curative or life-prolonging treatments
• Relief of physical suffering
• Attention to emotional needs

For the patient going through life-prolonging treatment, palliative care increases the likelihood that they will be able to cope with therapy and maintain a satisfying quality of life.  For the dying patient, palliative care, like hospice care, addresses comfort for the patient and preparation of both the patient and family for the inevitability of dying.

Hospice care focuses on relief of physical and emotional suffering and according to Federal law is available to patients when a physician certifies their life expectancy can reasonably be expected to be six months or less. However, doctors will tell you that no one can accurately predict the time of death.  Some patients live well beyond the six month period and are simply re-certified.  If a patient's prognosis substantially improves, they can be discharged from hospice and readmitted at a later time.   

Depending on circumstance, palliative or hospice care can be provided at home, in nursing homes, in a hospice center or in a special palliative unit in a hospital.  The hospital option is generally used when adequate pain relief cannot be provided elsewhere.

Sometimes people choose against palliative or hospice care because they think it means giving up.  It's important to know there's a difference between giving up and letting go. 

Giving up generates feelings of helplessness and hopelessness.  Letting go can provide opportunities for you and your family to grow, individually and together.  It can allow families to create memories that are not about pain and suffering but about being able to help their loved one and be with them at the end in a meaningful way.