Intended for healthcare professionals


Recent advances in palliative care

BMJ 2001; 322 doi: (Published 27 January 2001) Cite this as: BMJ 2001;322:234

United Kingdom continues to lead in palliative care

  1. Peter W Szlosarek, clinical research fellow (szlos{at}
  1. 44 Lincoln's Inn Fields, London WC2A 3PX
  2. Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH

    EDITOR—It was disappointing to read Billings's review on palliative care.1 Many of the so called recent advances mentioned in the first part of the article have been practised for many years in the management of British patients with a terminal condition. Much of the second half of the article does palliative care a deep injustice.

    The object of good palliative care is always the alleviation of suffering; hastening death is never the intention. It is wrong to suggest that most dying patients are unable to make decisions and that dehydration with the intention of committing euthanasia is an acceptable management option.

    The situation in Oregon, with the promotion of physician assisted suicide, and that in the Netherlands, with high levels of involuntary killing, are a direct consequence of poor access to good palliative care. The United Kingdom pioneered palliative care and continues to lead in it.


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    Importance of palliative care for children is being increasingly recognised

    1. Ann Goldman (ann.goldman{at}, covenor, Palliative Care Working Group, Royal College of Paediatrics and Child Health
    1. 44 Lincoln's Inn Fields, London WC2A 3PX
    2. Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH

      EDITOR—Billings writes about the palliative care needs of adults.1 Although fewer children than adults die, they also require palliative care. I am writing on behalf of the Palliative Care Working Group of the Royal College of Paediatrics and Child Health, which wants to alert readers to some of the special needs of children. 2 3

      The illnesses from which children die are different from those from which adults die, and paediatric palliative care has emphasised the importance of developing services for children other than just those with cancer. The need for palliative care arises in four broad groups:

      • Life threatening conditions for which treatment is available but may fail—for example, cancer

      • Conditions in which premature death is expected but long periods of intensive treatment to prolong good quality life are anticipated—for example, cystic fibrosis, HIV infection/AIDS

      • Progressive conditions that may extend over many years and for which no curative treatment is available—for example, Batten disease, mucopolysaccharidoses

      • Conditions with severe disability that, although not progressive, lead to extreme vulnerability and in which premature death is likely—for example, cerebral palsy.

      The continuing physical, emotional, and cognitive development in children sets them apart from adults. It influences all aspects of their care, including pharmacological treatment, their understanding of their disease, their communication skills, and their level of dependence.

      Parents are usually the main carers for children, with care taking place at home. They and the child's siblings will need support throughout the child's illness and their bereavement.

      Often, many professional and voluntary agencies are involved, as skill in different aspects of paediatrics and palliative care is needed. Care in hospital, care at home, respite care, and education all need to be coordinated, and community paediatric nurses often do this as key workers.

      Many children have prolonged illnesses; an integrated approach is then required, with a gradual change in the emphasis of care between treatments aiming to cure or prolong life and palliative care, rather than one having rigid boundaries.

      Although palliative care for children is a relatively young specialty, its importance is being increasingly recognised. The Royal College of Paediatrics and Child Health has established a special interest group to promote the best possible care and develop medical training. Similar commitment exists in nursing. The voluntary sector contributes heavily, particularly with children's hospices, and government help has come through the “Diana nurses” project.


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