What is Palliative Care?
According to the Center to Advance Palliative Care, “Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.”
Inherent in this definition are the following principles:
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Palliative medicine affirms life and regards death as a natural process. Along with that, palliative medicine intends to neither hasten nor postpone death
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Palliative medicine integrates the psychological and spiritual aspects of patient care
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Palliative medicine utilizes an interdisciplinary team - often composed of physicians, nurses, licensed clinical social workers, pharmacists, and chaplains - to provide a support system which allows patients to live as comfortably and actively as possible until death
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Palliative medicine is applicable early in the course of illness and in conjunction with other disease-directed treatments which are intended to prolong life, including chemotherapy, radiation or surgery. It can be delivered at home, in the clinic or in the hospital. In fact, the majority of palliative care is delivered to patients in the outpatient setting who are still getting treatment for their disease
Palliative medicine is not the same hospice. If palliative medicine were a pizza pie, hospice would be just one slice of the pie, reserved specifically for patients who have six months or less to live (though some patients end up living much longer) and, just as importantly, for whom disease-directed treatments are no longer aligned with their values.
Most people are surprised to learn that the term Palliative Care was coined by a surgeon, Dr. Balfour Mount. Dr. Mount trained as a urologic oncologist under Dr. Willet Whitmore at Memorial Sloan Kettering in New York City and spent his career practicing at the Royal Victoria Hospital in Montreal, Canada. In the early 1970s, Dr. Mount heard a talk by Dr. Elizabeth Kubler Ross about death and dying.
He was so moved that he eventually travelled to England to study with Dame Cicely Saunders, the founder of the modern hospice movement. When he returned to Montreal, Dr. Mount created the first inpatient palliative care unit in North America with the goal of anticipating, preventing and treating the suffering that many patients experience in the late phases of life limiting illnesses.
In the United States, surgeons played an important role in the early hospice movement.
Dr. Jack Zimmerman trained as a cardiothoracic surgeon under Dr. Alfred Blalock at Johns Hopkins and wrote extensively about the use of Souttar Tube, an early esophageal stent that he utilized as a palliative treatment for patients with esophageal cancer. In 1977, he helped to found the fifth hospice program in the United States, the Church Home and Hospital Hospice.
Dr. Bob Milch, a general surgeon from Amherst, New York, co-founded Hospice Buffalo and served as its medical director. Along with Dr. Geoffrey Dunn, he was responsible for introducing the concept of palliative care to the American College of Surgeons.
