Tuesday, September 16, 2014

To cure almost always, to relieve often, to comfort if we have the time?
A Challenge to Palliative Care

(Please welcome Cory Ingram, MD, MS, FAAHPM to Pallimed.  Dr. Ingram recently attended the 2014 Palliative Care Congress in Montreal at McGill University, "the birthplace of palliative care." He posted many pearls from the meeting to Twitter, and I asked if he would be so kind to summarize his trip to this great conference. Please enjoy! - Ed.)

When Balfour Mount, father of Palliative Medicine in North America, coined the term Palliative Care more than 40 years ago it may have been difficult to envision 1600 people from more than 60 countries making their pilgrimage to Montreal for the biannual celebration of the specialty at the 20th International Congress on Palliative Care. In speaking with colleagues from around the globe the theme that brings them back is consistent. This conference is for the heart.

The congress content is suited for the interdisciplinary nature of the specialities and attendees from around the world. It kicked off with several day long pre-conference workshops. Dr. Tom Hutchinson, editor of the text Whole Person Care*, created a brilliantly constructed day to deeply examine whole person care for persons with cognitive impairment. The day offered a medical review of cognitive impairment followed by a personal account of caring for a loved one with dementia. The question of the personhood and maintenance of personhood while living with dementia was explored prior to an insight into the repercussions for families caring for a loved one with dementia. Preceding a panel discussion, the role of the community was highlighted. It is interesting to think of how we speak about institutionalized persons with dementia as no longer living in the community.

In McGill tradition, the plenary sessions were opened with moving reflections. One reflection set to beautiful music titled “Fragile” from France, which played while photographic images streamed portraying the fragility of life. Plenary sessions with speakers from around the world identified challenges for us to consider for ourselves and those we care for in palliative care. What are the roles of forgiving and forgetting? How do we foster a balance between holding on and letting go? How do you let go if you have nothing to hold on to? How do we balance being proactive and letting things happen naturally? How do we access the spiritual dimensions that are not readily accessible? How do we transfer a fight to control to a search for the meaning of suffering? Is the heart of medicine ultra performance? Where is the art? Where is the lived experience?

In conclusion, the paradigm of the future of medicine is one where palliative care is central to the core of care for all persons. To this end, the Montreal Declaration was created as a formal request for inclusion of palliative care in the United Nations 15 year health targets. You can add your voice to the growing support for the Montreal Declaration by signing on.

Take home messages:

1. Provide whole person palliative care.
2. Understand that palliative care is at a cross road of the humanities and sciences.
3. Avoid limiting our scope to symptomotologists.
4. Maintain “radical presence” to the humanity of another.
5. The art of palliative care is to find the core of each and every person.
6. Dr. Chochinov and Canadian Virtual Hospice launch a new film on Dignity Conserving Care.
7. The elephant in the room is Euthanasia this year in Canada.
8. Euthanasia is not about end of life care….rather it is about life ending procedures.
9. Euthanasia has no place in palliative care.
10. Stay true to the founding principles of palliative care with attention to total pain of the whole person and their family.

Cory Ingram, MD, MS, FAAHPM is a Senior Associate Consultant in Palliative Medicine, Senior Associate Consultant Palliative Medicine, Assistant Professor of Palliative and Family Medicine, Director of Palliative Medicine Mayo Clinic Health System, Director of Palliative Medicine Office of Population Health Management all at the Mayo Clinic in Rochester, MN. The views expressed in this article are my own and do not reflect the views of my employer.

*Link is an Amazon Affiliate link with proceeds going to Pallimed

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