Abstract
Dear Editor:
It was with some sadness that I came upon the term palliative patient in the title of an article in the August 2012 edition of the journal Minor Children of Palliative Patients: A Systematic Review of Psychosocial Family Interventions. It is my personal view that the use of the term palliative patient, as opposed to palliative care patient, is an inappropriate and demeaning way to describe the people we care for by defining them solely on the basis of their life limiting disease, reductionism at its least attractive.
Writing in 1963 of her experiences at St. Joseph's in London, Cicely Saunders reported that 90% of her patients died within three months. 1 In 1967, when St. Christopher's Hospice opened, medical oncological treatment was, by today's standards, primitive. 2 The mainstay of analgesia at that time was the Bromptom Cocktail/Mixture, a variable, but undoubtedly delicious, cocktail of morphine or heroin, gin or ethyl alcohol, cocaine and chlorpromazine; the opioid as the essential analgesic ingredient was not identified by Melzak and colleagues until 1979. 3 If there has ever been a time when it was permissible to refer to palliative patients, that was it, but that time has passed.
Since that time, oncological treatment and disease trajectories have changed beyond recognition, with some cancers becoming chronic diseases, breast and prostate for example. Patients with cancer now live with comorbidities, which require management in their own right, heart failure or COPD; indeed, as palliative medicine expands into the field of nonmalignant disease, the border between palliative medicine and, for want of a better term, curative medicine, becomes increasingly difficult to discern.
Patients known to a palliative care service are palliative only in regard to the disease, which is considered to require intervention by the palliative care service; palliative care and curative care can and should run in parallel when required; while treatment can be palliative, patients in their wholeness cannot. Great care must be taken to ensure that acutely ill patients known to a palliative care service are not denied access to appropriate curative care; palliative care is not uncommonly misinterpreted as terminal care. Referring to people as palliative places this in jeopardy, something with which all palliative care physicians will have struggled and will have witnessed.
In 2008 Geoffrey Hanks, writing as editor-in-chief of the journal Palliative Medicine, described the term palliative patient as a “solecism” that failed to recognize the complexity of the practice of palliative medicine based on “four elements of continuing care: symptom control, rehabilitation, continuity of care and terminal care.” Furthermore, he indicated his intention to expunge the term from the journal of which he was editor-in-chief; 4 maybe it is time for the Journal of Palliative Medicine to follow suit.
The views expressed here are my own and may not reflect the views of my employing organization; although I hope that they do.