Intended for healthcare professionals

Rapid response to:

Analysis

Palliative care from diagnosis to death

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j878 (Published 27 February 2017) Cite this as: BMJ 2017;356:j878

Rapid Response:

Why do clinicians find labels such as Palliative so appealing ?

I do not question the possibility that the offer of 'palliative care' might be helpful immediately following a terminal diagnosis: but why do we need to emphasise the difference between 'palliative' and 'curative' treatments, in the period between a terminal diagnosis and the death ? I have made this point before, in a comment to an article with a similar theme by Mason and Murray (the article and the comments can be found as ref 1, and also a reply to my comment from the authors). Surely doctors should be considering all of the treatments which might help the patient, and offering those treatments to the patient: explaining the clinical effect of an offered treatment ('this treatment will not be a cure, but it will probably help with ...', or 'these tablets should cure your chest infection') surely involves making clear to the patient what it palliative and what is curative.

As I commented in ref 1:

Why do clinicians seem to imply that 'a patient is either 'palliative' or 'not palliative'' ? Why should it be assumed that any particular patient is only being given 'palliative' (which I define as 'non-curative') treatment, or only being given 'curative' treatments ? During normal life, you might have curative and 'palliative' (normally something such as pain relief) treatments together - so why, during 'end-of-life', do we need a 'palliative label' ?

The 'rules' of 'offer the best care you are able to provide, and then do whatever the patient consents to' apply irrespective of the situation: that is the ethical and legal 'rule' whether in normal, end-of-life, or dying-phase clinical situations - this 'palliative label' runs the risk of the label of 'a palliative patient' which could serve to incorrectly reduce patient choice, and to lead various clinicians to not properly obtain Informed Consent.

Ref 1 https://www.mariecurie.org.uk/blog/gps-patients-palliative-care-planning...

Competing interests: No competing interests

28 February 2017
Michael H Stone
Retired Non Clinical
None Private Individual
Coventry CV2 4HN