Issue #11a: Spread the Word About On Our Own Terms
You may be interested in forwarding to a friend this
article about a new approach to caring for people at the
end of life. It is the subject of a major PBS series from
Bill Moyers that will be on television September 10-13 at
9 pm each evening. The series is called On Our Own Terms:
Moyers on Dying. This article is from the series
discussion guide and it can be found along with a great
deal more information on end-of-life issues at:
"Pain is a more terrible lord of mankind than even
death itself." -- Albert Schweitzer, M.D.
by Ira Byock, M.D.
Palliative care is
comprehensive care for people with life-limiting illness.
It is a team approach focusing on the needs of ill people
and their families. Palliative care is valuable at any
time during a serious illness; one doesn't have to be
dying to benefit. Patients can continue to fight their
disease, while palliative care focuses on improving their
quality of life. Hospice is one form of palliative care.
Like hospice, palliative care can be provided in a variety
of settings including hospitals, nursing homes, and a
patient's home. Currently, in order to receive hospice
care, a doctor has to certify that a patient's life
expectancy is six months or less and both patient and
doctor must agree to forgo further surgery, radiation or
chemotherapy directed at prolonging life. Palliative care
attempts to avoid these conditions and seeks to serve
people earlier in the course of illness.
Physical comfort is the first priority for palliative
care, but it is not the ultimate goal. Relief of pain,
breathlessness, or other physical discomfort is precious
in its own right. But this respite also allows people the
time and energy needed to attend to deeply personal
questions that serious illness imposes. "Now that I am
sick and not likely to get better, what matters most?" "If
I were to die suddenly, what would be left undone?"
Palliative care is distinguished among clinical
specialties in acknowledging that dying is normal--part of
the life of every individual, and every family. Relatives
and close friends are deeply affected by their loved one's
illness and approaching death. They are often inundated
with the day-to-day, moment-to-moment, practical, and
difficult tasks of caregiving. Improving the experience of
living for seriously ill patients and their families is,
therefore, another primary goal of palliative care. And
because a family's experience of terminal illness and a
loved one's passing does not end at the moment of death,
palliative care extends support for the family in their
A typical hospice or palliative-care team may include one
or more doctors, nurses, social workers, home health and
bathing aides, pharmacists, chaplains, and physical and
occupational therapists. Increasingly, teams also draw
upon the skills and services of complementary therapists.
Trained volunteers are critically important resources of
palliative-care teams. They may help with housekeeping,
perhaps cooking or running errands, or making an afternoon
outing possible. The essential service volunteers provide
is the gift of their time and undivided personal
Dying is almost always hard, but it need not be horrible.
With skillful guidance, hospice and palliative care can
help people deal with the stress of advancing illness and
disability and the inherent sadness of dying. When a
measure of comfort is assured, people often find valuable
opportunities: a chance to communicate their feelings to
key people in their lives; a chance to reconcile
previously strained relationships; a chance to tell
treasured stories; a chance for healing the pain of one's
past; and a chance to come to peace with one's life-long
expectations and frustrations. These are opportunities to
explore meaning and to connect to a spiritual realm, not
out of a sense of desperation, but because these have
become the things that matter most.
The process of life completion can enrich the quality of
the ill person's remaining days and affect the lives of
family members for years to come. While the effective
management of symptoms remains fundamental, palliative
care strives to promote opportunities for the person and
family to grow, individually and together, during this
poignant and often precious time of life.
If you think you or a family member would benefit from
hospice or palliative care, you are probably right! Ask
your doctor or nurse to help. Even when it is not possible
to add many days to life, the opportunity exists to add
life to one's days.