Despite decades of advocacy, far too many people globally continue to perceive ‘palliative care’ negatively, equating it with the withdrawal of curative hope and the pessimistic acceptance of death’s inevitability.
Exploring these two perceptions, (i) palliative care certainly does not provide curative options, but these nevertheless can be provided concurrently in the disease trajectory if deemed appropriate. However, it does provide the reflective space for patients and their families to consider if aggressive medical interventions that appease the often desperate desire to ‘do something’ rather than necessarily ‘do something that will work’, is really necessary or indeed desirable.
(ii) Concerns regarding death are deeply enmeshed within a complex socio-cultural tapestry of suspicions, beliefs, taboos and rituals. Worries over the inevitability of death appear to be more evident in economically developed countries. In such nations there appears to be a denial of our own mortality that is underpinned by an erroneous belief in the life-preserving abilities of medico-scientific advances.
As one of the founding fathers of the US, Benjamin Franklin, famously noted, “In this world nothing can be said to be certain, except death and taxes.” Both are definite in life; but at least taxes can be differentially applied to people depending upon their personal income.
But death … it is the great leveler, that which disregards individual differences and worldly considerations. It is egalitarianism at its most ruthless.
Death is an inevitable part of our lifecycles. What is therefore important, irrespective of your worldview, is that the process of death is supported by the best quality of care provision possible; and that is what palliative care strives to do across the globe, whether you are New York or Nairobi.
And that’s an immense positive – supporting, comforting and giving solace to patients and families experiencing one of the most difficult transitions in life: death. Indeed, there appears to be an increasing acceptance among populations in, for example, Europe and Africa, that increasing the quality of the days remaining in one’s life is more important than simply extending those lives per se.
So palliative care does what traditional health services do not and cannot do: it embraces the individual in their totality. It addresses the patient’s needs holistically, seeing individuals as more than a disembodied diagnosis, but rather focusing on their ‘total pain’. This can be physical, psychological, social and / or spiritual and should always be from the point of diagnosis.
In performing this role, palliative care professionals are an integral and immensely valued part of what is an intensely intimate connection with our own humanity, at a time when our mortality is finally acknowledged and anxieties surrounding the inevitability of death are addressed for both patients and families by a deep professional compassion.
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