Principles in palliative care: an overview
Fins, J.J.
Respiratory Care 45(11) 1320-1326; Discussion: 1326-1330
2000
ISSN/ISBN: 0020-1324 PMID: 11063520 Document Number: 7425
The implicit lesson from futility disputes-and the other clinical examples just considered-is the importance of enhanced communication between clinician, patient, and family. Palliative care is simply the exchange of curative goals of care for comfort measures. Such a transformation of the clinical objective is only possible if the clinician can ease patient and family down the tangent c/h/dt gently over time. The point is not to impose the clinician's perspective on the patient and/or family but to negotiate a compromise. Indeed, it is critical to note that the clinician's tangent is not necessarily accurate and may be overly reductionistic or ill-informed of the patient's cultural or religious beliefs. Instead, the goal is to reach a mutual understanding about disease trajectory and what goals of care would be appropriate given the changing medical facts and the broader psychosocial narrative. The goal should be compromise- or a negotiated consensus-as depicted in tangent (b). In successful efforts of conflict resolution over futility disputes, the slope of both tangents (a) and (c) change. This is indicative of changing expectations about disease trajectory. When this compromise is reached, the perspectives of clinician, patient, and family coalesce into a consensus that allows for the transformation of the goals of care from one dominated by cure to one that is more accepting of care. That moment often represents an epiphany because it is only then that the principles of palliative care are realized both in theory and in practice.
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