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I'd tend to put myself into the other camp, that doctors tend to be too slow to reach for palliative care options, but your comment is thought provoking. A lot

I'd tend to put myself into the other camp, that doctors tend to be too slow to reach for palliative care options, but your comment is thought provoking. A lot of my thoughts on this were shaped by Atul Gawande's 2014 book on the topic of end of life care and the suffering that can arise from never "giving up." Your anecdote about feeling the doctors were too quick to suggest palliative care makes me wonder if it was the exception or if the pendulum is now swinging the other way. I'd say the viewpoint of the article is pretty in line with Gawande's as well. > Should we minimize the suffering when there's no hope? Definitely. But not until that point unless the patient clearly chooses otherwise. There are so many things to weigh here, I can't imagine having to help other people make this choice. How do you decide when there is no hope? When literally every possibility has been exhausted? How do you decide when the hope that remains is likely outweighed by the suffering that will be endured to achieve it? What is an appropriate amount of suffering for a 1 in 4 chance of a few more good years, or a 1 in 10 chance, or a 1 in 25 chance? What is the break even point in terms of quality of life where it's better to have a gradual decline at home and then in hospice rather than spending the only months or years you have left under a battery of treatments to buy the lottery ticket that you might come out well-ish in the other side?

wpietri 4y ago
> other camp, that doctors tend to be too slow to reach for palliative care options I don't see a need for camps here. Both can be true! Some people can get over-treated. Some people can get under-treated. These are both problems that we should fix. > I can't imagine having to help other people make this choice These are inevitably personal decisions. There are few wrong choices, and often few good ones. In my limited experience, the doctors who specialize in these sorts of thing are pretty good at helping with that choice. They explain the options, say what they can about the odds, and then let the patients and their families decide. Which is why it's crucial that families talk about these questions before it matters. We need to understand our loved ones' preferences and views, and they need to understand ours. Because once it comes to it, at best it will be a very fraught and difficult time. And at worst, the patient may not be in any state to answer the questions.
dtgriscom 4y ago
> Atul Gawande's 2014 book on the topic of end of life care "Being Mortal." An excellent book. We and all our loved ones will die; until you come to terms with that, you will not be able to make good decisions as the end approaches.

wpietri 4y ago

> other camp, that doctors tend to be too slow to reach for palliative care options I don't see a need for camps here. Both can be true! Some people can get over-treated. Some people can get under-treated. These are both problems that we should fix. > I can't imagine having to help other people make this choice These are inevitably personal decisions. There are few wrong choices, and often few good ones. In my limited experience, the doctors who specialize in these sorts of thing are pretty good at helping with that choice. They explain the options, say what they can about the odds, and then let the patients and their families decide. Which is why it's crucial that families talk about these questions before it matters. We need to understand our loved ones' preferences and views, and they need to understand ours. Because once it comes to it, at best it will be a very fraught and difficult time. And at worst, the patient may not be in any state to answer the questions.

dtgriscom 4y ago

> Atul Gawande's 2014 book on the topic of end of life care "Being Mortal." An excellent book. We and all our loved ones will die; until you come to terms with that, you will not be able to make good decisions as the end approaches.