Hospice, palliative care needs discussing

By Dr. James Bell

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Now more than ever, people are engaged in discussion about health care reform. End-of-life care is an important part of this discussion for a number of reasons.

First, as much as we hate to admit it, in America, we don't do a great job of focusing on quality of life in medical decision-making when facing serious illness. We can do better, and the specialty of hospice and palliative care is meant to do exactly that - filter medical choices through the lens of quality of life when things are serious.

Second, people are uncomfortable and sometimes very intimidated talking about end-of-life choices. In an age of high technology and dramatic new treatments, it has unfortunately become a sign of “failure” to reach a point where the reality is that treatment choices may actually cause more suffering than they help, or that the end of life may be coming into view.

It always makes me sad to hear patients and doctors alike speak of “giving up.” Palliative care and hospice are not about giving up anything, but rather about refocusing priorities and care - and there's almost always something to be done that will improve quality of life.

Hospice and palliative care provide a legitimate forum for discussing these difficult issues without the stigma of being a scary death panel.

Finally, we have to face the reality that things have to change in the world of paying for care. Again, hospice and palliative care will be an important part of this discussion. It is an ironic but little-publicized fact that the more money we spend on high-technology interventions at the end of life, the lower the perception of quality of life. In the United States, we spend more than 16 percent of our GDP on health care - more than twice what any other country does - and we have the lowest scores on many measures of life expectancy and quality of any developed nation. We can and must do better.

There are excellent resources available in our area to improve awareness and access to this type of care. Check out websites such as

getpalliativecare.org,

and talk to your health-care provider.

Dr. James Bell is St. Luke's Hospital's palliative care and hospice medical director. Comments: belljr@ihs.org