This Sunday I was struck by the New York Times article titled “Helping Patients Face Death, She Fought to Live,” about Dr. Desiree Pardi, a leading clinician in palliative care who herself became a cancer patient faced with deciding when to stop treatment and when to focus on palliative care instead.
As a practitioner and health care advocate, I have often found myself involved with patients who are at the crossroads of ending active treatment and focusing on comfort care. This article highlights well the personal nature of such a decision. As practitioners, we can provide information and support, but it is the patient who ultimately must choose which path to follow.
I believe that in a situation in which a patient and physician find themselves at odds regarding topics of continuation or end of treatment, a mediator should be consulted to help resolve these difficult issues. In the best case scenario a medical ethicist or palliative care practitioner should be asked to help to ease the burden that both the patient and healthcare provider are struggling with. In theory, paternalistic medicine is no longer practiced and as healthcare providers, we are tasked with providing the patient with the education to make informed decisions (choices). This also implies that a patient is able to make those choices based on free will and a good understanding of the impact the choice will have on their lifespan. I imagine that as healthcare reform continues to evolve, end of life decision-making will become part of a national debate. I know that, as a medical provider, I will continue to learn from my patients and their loved ones.