END-OF-LIFE CARE FOR TERMINALLY ILL CLIENTS

End-of-Life Care for Terminally Ill Clients



End-of-Life Care for Terminally Ill Clients

Introduction

Almost every medical specialist at some point interacts with patients who are dying. With its dramatic advances in biomedical research and the ability to treat disease and prolong life, however, modern medicine--until recently--has neglected its traditional role of comforting patients and their families when end of life is near. Moreover, one characteristic of modern medicine in the United States is the absence of any specialty of palliative medicine as such. The few specialists who have focused most of their efforts on end-of-life care have come from internal medicine, family medicine, and oncology as well as--to some degree--neurology and anesthesia, with their expertise in pain management (Veech RL. 2004). Since 1997, a significant number of specialty societies, as well as the Joint Commission on Accreditation of Healthcare Organizations, have endorsed or adopted a consistent set of Core Principles for End-of-Life Care (see box). Some have adopted these principles with minor modifications. Others have issued policy and/or other statements elaborating on the principles in the context of their specialties. Certain principles are common to all and the groups have come to consensus on these. This report summarizes how some of these specialty groups have adapted these principles to their own unique circumstances and describes how they have identified their important roles in end of life care.

Problem of End-of-Life Care

Almost 2.5 million Americans die each year; the majority are over the age of 65. The leading causes of death cardiovascular disease and cancer vary with age, however. For example, of those over 65, only 23 percent die of cancer. With progressive aging, many die with disorders complicated by neurobiological disorders such as Parkinson's or Alzheimer's disease or by stroke. This wide range of clinical disorders demands that improved care of the dying become the focus of all medical specialists who will encounter dying patients during the course of their practice (Schattner M. 2003).

In addition, the Institute of Medicine report of 1997 points out that there are different trajectories of dying, depending on the underlying health status of the patient and the nature of the terminal illness.1 A person dying from congestive heart failure or liver disease may have very different clinical needs than someone dying from lung cancer, and some people may need highly specific specialty care. In our scientifically advanced health care world, different specialties may see different aspects of the care of dying patients. It is therefore imperative that they agree on the basic principles underlying their roles and responsibilities in end-of-life care (Roberts S, Miller J, Pineiro L, Jennings L. 2003).

Palliative Care and the Specialties of Medicine

American medicine is specialty based, and much of its strength lies in the strength of its specialty societies. To broaden the specialty base of attention to end-of-life care, we convened representatives of 13 surgical and other medical specialties, as well as subspecialties in internal medicine (including the American Medical Association), in September 1996 to discuss access to and ...