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.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.
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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.
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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7 Responses to “The Palliative Pope; Letters; EBM Bashing; Diamorphine; UK euthanasia”
February 22, 2007
Dr. Sinclair,
My name’s Lori, and I write for a company called Gilbert Guide (the foremost resource for everything senior care.) I’m always trolling the internet for new information about seniors’ quality-of-life. I was particularly interested in the article on evidence-based medicine—more specifically, the potential for insurance companies to deny coverage based on evidence-based arguments. I look forward to following the commentary on this blog to see what others think—both about EBM and the LA Times letters to the editor about palliative care. Thank you for posting this thought-provoking post.
Lori
Gilbert Guide
February 22, 2007
Hi Lori,
The article from Time magazine is available online (for now). The tricky thing with evidence based medicine is that you still have to know how to apply it to certain situations that are not always covered by the evidence.
The funny thing is, I came across your comment not more than two minutes after I visited the Gilbert Guide for the first time, because and alert for a hospice article was sent to me about on your website. Small world huh?
Thanks for the comment. Enjoy our site.
February 22, 2007
Well we all love to bash EBM as much as we pine for, well, evidence...
My favorite quote about EBM goes something like "The problem with EBM is that there are no evidence-based patients."
February 24, 2007
Just discovered your excellent site.
I am not a Catholic, but I share many of your views and, in particular, I am implacably opposed to physician assisted euthanasia.
In 25 years of practicicing medicine, and having cared for many (too many) patients who are terminally ill, I have never been asked by one to help him die.
It is my firm belief that good symptomatic care should mean that such a request should never arise.
As to the routine use of diamorphine (heroin) : yes, we all can and do use this routinely and in preferrence to morphine or oxycodone. There has never been any problem with patients or, more likely, the media associating it with drug addicts and so on. It just is not an issue.
Why do I prefer diamorphine? Habit and practice mainly I guess. I am used to the doses, the diltutions and so on. It IS much more dilutable than other narcotics for syringe drivers and so on.
It would be a shame if medical useage was stopped. The main problem we have in this area is the influence that is slipping over the Atlantic from you guys!!
But I would not get hung up on diamorphine.
The most important issue is the care of the patient.
We have been very lucky in the UK to have had the great Dame Cicely Saunders who, with her wonderful work at St Christophers Hospice, showed us all how to care for the dying.
I cannot improve on this:
“You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die.” (Dame Cicely Saunders)
http://nhsblogdoc.blogspot.com/2006/08/removing-death-from-life.html
John
February 24, 2007
John,
Good to have you here! I have enjoyed reading your site over the last couple of weeks. It is interesting to see the differences & similarities between our two health care systems.
I am not Catholic either, but working at a Catholic based hospital on end-of-life care issues, you tend to keep an ear out for anything the Pope says so that you can help discuss his words with patients and staff.
On the diamorphine issue, I was just thinking out loud, mostly I would like to have another medicine to work with because I feel limited when we run out of choices, but issues with opioids and fears of addiction seem to play strong here in the States at least the areas I have worked in.
I have always liked that Saunders quote too.
February 24, 2007
John,
Good to have you here! I have enjoyed reading your site over the last couple of weeks. It is interesting to see the differences & similarities between our two health care systems.
I am not Catholic either, but working at a Catholic based hospital on end-of-life care issues, you tend to keep an ear out for anything the Pope says so that you can help discuss his words with patients and staff.
On the diamorphine issue, I was just thinking out loud, mostly I would like to have another medicine to work with because I feel limited when we run out of choices, but issues with opioids and fears of addiction seem to play strong here in the States at least the areas I have worked in.
I have always liked that Saunders quote too.
February 25, 2007
John thanks for you comment. Love your post that you linked to...I hadn't quite realized that there were restrictions to hospice care in the UK for people without cancer--what do other people do?
I particularly appreciate your mentioning of two things: the rhetorical cloaking of death/dying and the (often unintentional) promulgation of the idea that death can be all sweetness and flowers, fun, just another consumer activity in which patients need to be empowered to 'choose.' Of course there are some choices, and some control patients/families/clinicans/health systems have over it--it can be 'better,' 'less ugly.' This doesn't change the fact that it is Death, permanent separation, and preceded under the best of circumstances by disability, anguish, grief, and bodily fluids.
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