Abstract
Dear Editor:
What will successful implementation of palliative care in the field of surgery look like? It will be successfully established when any seriously ill surgical patient and his or her family know to request palliative care; all surgeons have the willingness, knowledge, and skills to ensure their patients will receive palliative care; and the surgical venue will be prepared and equipped to provide palliative care. This will require not only a change in the cognitive and technical repertoire of the surgeon, but also an inner change of the surgical character that is willing to risk some degree of psychological and spiritual reflection and introspection. In the past, surgeons have made similarly significant adjustments. The eighteenth-century surgeon who relied on speed and callousness to accomplish life-saving amputations yielded to the more deliberate, cerebral, and gentler surgeon of the late nineteenth and twentieth century who performed reconstructions. It seems particularly appropriate in the current era of social networking and globalization to ask if the surgeon of the twenty-first century will be noted for the ability to recognize the impact of his or her intervention beyond the merely physical and the individual patient.
Palliative care is not care for the dying, but care of people with serious or life-limiting illness, some of whom will die imminently. To limit the concept of palliative care to the dying only reinforces the current Western dichotomous view of life and death, which could be summarized as “all or nothing” or “fight or flight.” The richness of palliative care lies in its recognition of the possible where there is uncertainty. There is nothing uncertain about robust health or active dying. This is an extension of the hospice philosophy that has facilitated the transition from “death as failure” to “dying as opportunity.” For those who actually are at the end of their life, palliative care offers the opportunity to die in peace instead of pieces. For those not at the end of life, palliative care offers the same hope: to live in peace, not piecemeal. The surgical world has too many seriously ill people in its care and has too much to offer the seriously ill with all diagnoses to not assume a leadership role for the continued growth and development of palliative care. Recent developments in the field of surgery give reason for optimism that this will occur.