The Politics of Palliative Care: A Way Forward?

In this tumultuous time of seemingly endless political power struggles, I find myself thinking how structure can subtly influence outcomes, and wondering if lessons learned from palliative care may be helpful in breaking through our current congressional gridlock. It is from my belief in the power of collaborative palliative practice that I reflect on lessons that offer not only an improved way of addressing patient suffering, but may also provide a way forward for our embattled political system.

Much of palliative care education focuses upon the need to develop more nuanced interdisciplinary communication so that a true understanding may develop between differing professionals working to address the complex multi-dimensional needs of seriously ill patients and distraught families. We have learned that the consultation model of palliative care fails to thrive when well-meaning specialists resort to criticizing their referring colleagues, belittling their skills, or even worse, questioning their character. We have discovered that the daily rhythms of medical care may unintentionally separate the very professionals who need to be working together and contribute to “professional silos”—much as the long-standing tradition of party affiliations ensures that extraordinary efforts are needed to literally “reach across the aisle” to the opposing side. Defining potential colleagues by one-dimensional party designations reinforces partisanship and impedes creative problem solving.

Palliative care professionals have painfully learned that demonizing the colleagues that one later hopes to influence proves an ineffective long-term strategy, and seems equally untenable in political practice. Perhaps if our politicians were to increase their daily interactions with one another in pursuit of a common goal, we might find that, as occurs with palliative care rounds, opportunities to know one another as individuals opens pathways to mutual understanding. We should not be surprised when our officials, following a bruising election, later fail to work cooperatively side by side.

Palliative care providers have made great progress in identifying the unintended consequences that contribute to the fragmentation that is emblematic of our current health care crisis. We have learned to seek areas of common ground and to break down the systemic and structural barriers that impede creative and collaborative transdisciplinary practice. If we can get physicians, nurses, social workers, and spiritual care professionals to put aside their differences for the good of the patient, I would like to think that Republicans and Democrats might as well. Our seriously ill nation depends upon it.