Living a full life
Palliative care should be an option for all critically ill patients around the country.
Most of us know of ill patients who are aggressively treated, only to die after much suffering. Many patients believe they have two options: aggressive treatment or death. There is an in-between option, but too often, palliative care or learning to live with a serious or end-oflife disease is not a consideration.
Palliative care — which is associated with better quality of care — should be an option for all critically ill patients around the country. Moreover, it should be an option that is listed up-front, not something that is only available on specific request.
Texas is nationally and internationally known for aggressive and effective end-of-life care, but our state lags behind the country in offering palliative care, according to the Center to Advance Palliative Care, which in its state-by-state report card on access graded Texas with a “C.” Only 66 percent of Texas hospitals with more than 300 beds offer palliative care programs and only 19 percent of hospitals with fewer than 50 beds.
In addition, most palliative care offerings are hospital-centric, meaning you have to be in a hospital center or actively dying to have access to palliative-care services. This leaves many people in our community facing tough choices, such as whether to go on life support or to accept a feeding tube, without the opportunity to consider palliative care as an alternative.
Our health-care providers are bound by oath to do everything that they can to extend lives, even after patients have lost contact with their loved ones and their meaning for existence. Making palliative care available to a larger community could substantially lower health-care costs, but more important, it will reduce suffering.
Although Medicare recently has begun offering reimbursement for end-of-life talks, the majority of health professionals today have had little to no training in pain management or skilled communication around end-of-life situations, according to the center. Training programs are needed to meet the chronic shortage of palliative-care specialists and to fill a gap in palliative-care skills among all types of clinicians.
While ultimately state and federal action is needed to expand access to palliative care, any successful effort must start on the ground. People of all ages need to become aware of the option and to better understand it. A patient can receive palliative care while pursuing treatment for disease. It is not “giving up.”
In a unique collaboration, Memorial Hermann, CHI St. Luke’s Health, Baylor College of Medicine, UT-Health and MD Anderson Cancer Center, along with many other institutions, have come together to sponsor an effort to help educate the public about alternatives. Next Tuesday, in “Let Me Down Easy,” actress Anna Deveare Smith channels a number of people — some famous, and some unknown — to explore issues surrounding survival, health care and mortality.
Former Gov. Ann Richards who died of cancer in 2006, is one of those channeled by Smith. Richards was typically feisty when she said, “I have two choices when I get up: I can feel good — or I can feel bad.” In the play, Smith shows how Richards was forced to adapt to live life fully to the end.
“If I fall, can you let me down easy baby,” go the lyrics to a popular song. There are no easy answers to end-of-life decisions, but other cities and states have implemented programs such as Honoring Choices in Minnesota, Massachusetts and Wisconsin that help people plan for the end of life.
With 2.5 million baby boomers turning 70 last year, the largest medical center in the world needs to engage the community in a dialogue about how we live life to the fullest to the end. The collaboration around this play is a good start.