06/17/2011 02:10 pm ET Updated Aug 17, 2011

Thanks to Dr. Jack Kevorkian

With the death of Dr. Jack Kevorkian many people are probably breathing a sigh of relief -- "Doctor Death" is dead.

Well, I have a different take on Dr. Kevorkian. I believe that he should actually be thanked because he raised the awareness that we don't do dying well, particularly when people are suffering and in physical pain. While I do not agree with his methods, Dr. Kevorkian forced a public dialogue about how we don't acknowledge or deal with those who are dying. I believe that the medical profession experienced a "wake-up call" because of Dr. Kevorkian and because of what some perceive Dr. Kevorkian provided -- a compassionate way for those who were suffering to die. Additionally, the Physician-Aid-in-Dying (PAD) Movement, which brought about PAD laws in Oregon and Washington State, by voter choice, and in Montana by Court order, also pushed this conversation forward.

Most people are afraid that they will die in pain and up until recently there was good reason to be afraid. Doctors were very careful not to give a patient too much morphine for fear of hastening death or bringing about an addictive response from the patient. Doctors should not be "blamed" for this -- the regulatory agencies watch dispensing of drugs like morphine very carefully and doctors could lose their license to practice medicine if there appears to be a misuse of drugs like morphine. However, with the rise of the Palliative Care specialization in medicine, people can now be almost assured that they will not die in pain. I say "almost" because Palliative Care teams are not present in all hospitals or communities, many doctors do not readily embrace palliative care, and there is a misperception that palliative care is Hospice Care.

It is important to understand the difference -- and there is a difference. Hospice provides patient-centered palliative care for the terminally ill, combining emotional, spiritual and social support with expert medical and nursing care. Hospice care can be provided at home or in freestanding hospice centers, hospitals, nursing homes and other long-term care facilities. Hospice is a wonderful alternative to dying in a hospital hooked up to machinery. Hospice allows for what most people prefer -- to die at home; unfortunately, most people die in the hospital and not at home. Hospice enables people to die surrounded by the people they love and the things in their homes that are familiar and comfortable to them and not in a sterile hospital environment.

The World Health Organization (WHO) defines palliative care as: an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Palliative care:
  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patient's illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. [1]
  • Palliative care is not the same as hospice care. Palliative care may be provided at any time during a person's illness, even from the time of diagnosis. And, it may be provided at the same time as curative treatment.

    Hospice care always includes palliative care. However, it is focused on terminally ill patients -- people who no longer seek treatments to try to cure their disease and who are expected to live for about six months or less.

    In other words, all hospice care is palliative care but all palliative care is not hospice care.

    More and more physicians are embracing the concepts of palliative care although, as I wrote above, not all physicians have come to understand that palliative care is "good" medicine, and most hospitals do not have a dedicated palliative care team.

    You have a right to palliative care if you are experiencing pain or other discomfort as a result of your diagnosis. So if you or a loved one has been diagnosed with a chronic or debilitating illness or disease, you can ask for a palliative care consult. Palliative care matches your life goals to the goals of your care and works to provide you with the quality of life that you desire.

    [1] (accessed 6/14/11)