Tuesday, February 20, 2007

The Palliative Pope; Letters; EBM Bashing; Diamorphine; UK euthanasia

1) Did anyone else miss the Pope talking about palliative care last weekend (Feb. 11)? Where was I?

I work at a Catholic hospital, so any pronouncement about health care by the Pope usually draws some attention. For those of you who also work with Catholic health care systems, you may want to read some of this and tie it in to your palliative care education. Maybe it will help with the administration supporting your efforts? I give you a few choice quotes from the article:

“There is a need to promote policies which create conditions where human beings can bear even incurable illnesses and death in a dignified manner,” he said, pointing to the need for more palliative care centers.

While the Catholic Church has always sought to follow the “example of the Good Samaritan” in showing “particular concern for the infirm,” the pope urged that Catholic health-care professionals, pastoral ministers, volunteers and family members to continue to “stand alongside the suffering and to attend to the dying striving to preserve their dignity at these significant moments of human existence.”


2) An interesting set of letters to the editor (link may expire) in the LA Times in response to a favorable article about San Diego Hospice:

Some quick excerpts from the two letters:
With their help and the invaluable help of hospice, she has had an unbelievable good turn in the quality of her life. She looks forward to her visits by hospice nurses, caregivers and social workers. It has taken much of the burden I had expected to carry. What a blessing it has been. Thank you for bringing these services into public view.
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The government is quite anxious for people not to seek the expensive treatment for diseases that cost a lot but usually extend life for a relatively short period of time. We have been bombarded in the media with the message that we should forgo treatment and "die with dignity." Let me tell you, death is never "dignified." The last few weeks of my mother's illness, she did have home hospice care. When the time came that she was no longer able to swallow, we asked that an IV be inserted to give her hydration and nutrition. The hospice service pressured us to not have it done. We are, in my opinion, being brainwashed to save money.
Well those are two very different views, but it does show that we must continue to strive to build trust of those we serve. As Drew and many others said, palliative care does not necessarily mean inexpensive care. There is often a great deal more resources poured into the human capital with palliative care as opposed to the technological but there is still a lot of time (and therefore money) being directed towards good quality end-of-life care based on evidence.

3) Speaking of evidence, the blog Overcoming Bias shone (shined?) a light on a Time magazine article bashing Evidence-Based Medicine. Now we here at Pallimed are pretty big fans of Evidence-Based Medicine but we also work in a specialty where we are just learning what the evidence is. The article and the blogger both feel that EBM will never really come of age especially if lawsuits against schools that teach it are the target of law suits. With that, i give a disclaimer...any medical information you read here at Pallimed, read at your own risk. Check the source material first, but if you do want to say you saw it on Pallimed to all you friends and co-workers, we always appreciate the reference.

4) A link to a current debate in Britain about the legalization of heroin for the treatment of addicts. The interesting thing for palliative care folks, is that our fellow practitioners in the UK have access to another opioid called diamorphine for pain control. Diamorphine is also known as heroin. While it would be nice to have access to another opioid for prescribing in complex pain situations, I do not think it would be worth the potential stigma of being DIRECTLY associated with heroin, an illegal narcotic in the US. Any comments on this stigma issue from our UK readers?

5) Also a great blogger, NHS Doctor, gives his thoughts and a few BBC links for the right to die case currently being debated in Britain that Drew just referenced.

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