Bioethics Blogs

Nobility and nihilism in palliative care

Last weekend, I attended the inaugural Palliative Care conference for the American Society of Clinical Oncology (ASCO).  Fifty years into ASCO’s existence, it now takes the formal position that good cancer medicine means integrating palliative care—addressing symptoms and “whole person” aspects of medical care—throughout the treatment of a person’s cancer, not just at the end of life.  And there has been a move to establish palliative care as a bona fide medical subspecialty, with all the benefits (disciplined research, careful attention to specific palliative care matters) and challenges (“turf” boundaries; fights over certification and grandfathering of older, experienced physicians; metrics to support reimbursement, academic department resourcing, and hospital accreditation) attendant thereto.

It strikes me as a noble endeavor consonant with the core of medicine:  emphasis on the whole person, and on listening to the patient; thoughtful treatments of what it means to start care planning early, and when and how to have end-of-life discussions; attention to just how well pain and other symptoms are controlled; energy spent toward understanding a patient’s broader concerns in the context of family, friends, and faith community; and so on.  To be sure, the conference raised questions (for future posts), like what the implications are of making documentation of a DNR conversation a metric (and the nagging, critically related issue of unilateral behavior by physicians and hospitals regarding DNRs, something that I DO intend to address further in the future). 

But I use “nihilism” in the title of this post because of some things that disturbed me.  This was a small meeting, but there were a few “exhibit” booths, by other subspecialty societies, a couple of medical device companies (e.g., patient-controlled pumps for morphine dose control)—and the group “Compassion and Choices,” formerly known as The Hemlock Society.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.