Palliative care

“ Hospice care plays an important role in American medicine by easing a patient's suffering while reaffirming individual dignity in a familiar, comfortable environment. Across our Nation, hospice care providers are assisting in hospitals, nursing homes, and private residences, offering physical, emotional, and spiritual support to patients who often have a short life expectancy. ”

“ The hospice movement in America is an organized voluntary effort to enhance health care for dying people and their families. Hospices, expanding rapidly as a vital component of health care, provide a compassionate way for terminally ill patients to approach death naturally in a supportive environment and surrounded by family members. ”

“ By offering a positive and supportive environment, as well as high quality medical care, hospice programs enable terminally ill persons to live peacefully and comfortably in their final days. In so doing, these facilities and services not only reaffirm the inherent dignity and worth of every individual but also demonstrate reverence for human life in all its stages. ”

“ An incurable disease under the circumstances speedily finds a fatal termination. A patient laid up with a disease, which only admits of a palliative treatment, lives so long as the course of the medical treatment is continued, and will die almost simultaneously with its discontinuance. Just as a prop or a pillar can prevent the collapse of a tumbling edifice, so palliative measures, judiciously applied by a skilful physician, may keep off the inevitable in a disease which knows no radical cure. ”

“ While we have made great progress in encouraging hospice care, much work remains to be done to increase awareness of hospice and its benefits. The NHPCO reports that in 2000, 2.4 million people in our Nation died. ”

“ The importance of hospices as an integral part of our Nation's health care system is increasingly recognized. The growth of hospices was encouraged in November 1983 when the Federal government added hospice care to the benefits available to people under Medicare. ”

“ This team provides medical services that are designed to improve the comfort of the patient, manage symptoms, provide proper nutrition, and deal with other difficulties such as emotional distress and grief. Hospice care also provides important emotional and spiritual support to families and friends as they cope with their impending loss. ”

“ All of these people see to the varied needs of patients and families. At present, small hospices, staffed largely by volunteers, are supplying much of the care to those in need, often without charge. But hospice care is increasingly a part of health care in America. Medicare has begun certifying hospices; Medicaid programs will provide hospice care; and many private insurance companies already offer hospice benefits. ”

“ Hospice organizations provide people who are near the end of their lives with family-centered, quality care, that emphasizes compassion, independence, respect, and dignity. During National Hospice Month, our Nation pays tribute to hospice care and the persons and organizations involved with it, by recognizing and honoring its value and importance for people who are dying, for their families and friends, and for our communities. ”

“ The compassion reflected in hospice care is one of the reasons America has the best health care system in the world. Our whole Nation is grateful for the good work of our dedicated medical professionals and hospice caregivers. By taking the time to care for others, they are making America a better place. ”

“ It is, however, permissible, after having legitimately excused one's self, to prescribe a palliative treatment. In diseases easy to cure, in recent small wounds—for example, boils, tumors, slight contusions, etc.—we may give a curative prescription to absent persons. We should laugh indeed at surgeons," he adds, "if the patient had to appear personally before them for a light disease as well as for a serious one. ”

“ The legislation also makes the program more flexible and responsive to the needs of patients, allows patients to designate a nurse practitioner to coordinate their hospice care, and directs the Secretary of Health and Human Services to explore ways to make hospice care more widely available to beneficiaries who live in rural areas. ”

“ Sometimes, alas! the care and nursing lavished upon the sick was unavailing. Death often invaded the "Rest." In every case the rites of burial were accorded. Women remembered tenderly the far-distant mother or wife, and therefore honored their dead.
For a few days after my patient had ceased to need special nursing I continued to serve with, the ladies attached to the little hospital on Clay Street, still longing, however, for a larger sphere of usefulness. ”

“ The disorder assumes a very obstinate character in this country; for though cured in the dry season, it generally presents itself again at the period of the rain,—a circumstance very easily explained, if we consider that the cure, what with their inacquaintance with the nature of the disease, and defective treatment, is generally palliative, or temporary, and never radical; hence many of these patients remain cripples for life. ”

“ This purely painless process, this descent by oblivious trance into oblivion, this natural physical death, is the true euthanasia; and it is the duty of those we call physicians to secure for man such good health as shall bear him in activity and happiness onward in his course to this goal. For euthanasia, though it be open to every one born of every race, is not to be had by any save through obedience to those laws which it is the mission of the physician to learn, to teach, and to enforce. Euthanasia is the sequel of health, the happy death engrafted on the perfect life. ”

“ The traditions as to the treatment of patients in these early times are such as to make us believe that hospital attendants did take their work seriously from a very lofty motive, and that while medicine and surgery were much less effective than in more modern times, the tender care of patients did as much as was possible to make inevitable suffering more bearable, and to keep the sight of painfully approaching death from being a source of discouragement and even of despair. ”

“ And further; even when the danger of death is past, the continuous care which can be given to patients in a hospital may restore many more to sound health, who in their own homes would only have escaped death to remain for the rest of their days miserable invalids.
The hospitals to be next mentioned are one for fistula and one for diseases of the hip. ”

“ For so, while the framework of the body remained whole, if any infirmity occurred in certain of its members, it might rather regain its health from their general soundness, than be deprived of the chance of any healing care by their death in severance from the body. ”

“ I also had a few people who were beyond help because their vital organs had been so badly damaged that they knew they were dying, and they wanted to die in peace without medical intervention, in a supportive hospice cared for by people who could confront death. ”

“ Before I proceed to speak of the radical cure of the consumption, it will be necessary to observe, that by means of the palliative remedies which have been mentioned, many persons have been recovered, and some have had their lives prolonged by them for many years; but in most of these cases I have found, upon inquiry, that the disease recurred as soon as the patient left off the use of his remedies, unless they were followed by necessary or voluntary exercise. ”

“ Why, it must be asked again, should all this unnecessary suffering be endured? The patient desires to die; his life can no longer be of use to others, and has become an intolerable burden to himself; the patient's friends submit to the inevitable, but seek the means of robbing death of its bitterest sting—protracted bodily pain; the medical attendant is at the bedside with all the resources of his knowledge and his skill ready to his hand; he could, were he permitted, bring to his patient immediate and permanent relief. ”

“ In Tuesday last he confessed to witness that he had shot himself four times through the chest, and expressed the fear that he had made a bad job of it. He died the following Saturday.
A letter fro the deceased to his brother read as follows: "I have a malignant disease. A sanatorium cure to me would be intolerable. All medical skill can do is at best, palliative. I have been suffering much pain and discomfort. The future must be all pain and sickness, and I should be a burden to myself and nuisance to everybody else. The best thing is to hasten the end. ”

“ But to face death in a great hospital camp such as this! To be all day and half the night visiting the sick and dying where there are no comforts, very little food, and the medicine has run short; to see that hospital steadily grow,—men on the bed-cots, men lying between them; to watch men struggling in the agonies of the disease, with dying men close beside them; to have to step over one prostrate figure to get to the side of some dying man and whisper words of comfort and prayer, while shrieks of agony come from either side ”

“ If he deals only with palliatives, to assuage for a brief period the present suffering, when he can remove the cause, and restore the patient to permanent and perfect health, he is but a quack and an impostor. ”

“ The body is to be kept in a warm room, for the double purpose of promoting decomposition if it be dead, and of preserving in it the vital spark if it still linger; and it should be constantly watched. But should every recently dead body be made the subject of similar care? it is natural to ask. There are, of course, many cases where such care is positively unnecessary—such, for instance, as death following great lesions of vital organs; and in the great majority of cases of seeming death, the bare possibility of the persistence of life hardly remains. ”

“ How important, then, to give prompt attention and skillful treatment to disease of these parts. When the ordinary palliative treatment, with ointments and with laxative agents to keep the bowels soluble, does not completely and perfectly subdue the malady, lose no time in securing the most skillful appliances, that every vestige of the affection may be promptly removed. We have treated many thousands of cases with uniform success, and our patients write to us expressing the greatest degree of satisfaction, and recommending our method most highly. ”

“ It first became the expression for the attempt of the physician—originating in human compassion, developed by medical science—to alleviate the end of a dying person by soothing his pain. But then the meaning of the word, and with it the concept of euthanasia, was expanded, and towards the end of the 19th century it meant assistance in dying through an abbreviation of life if the life of the suffering person had lost its value in view of immediate and painful death, or as a result of an incurable disease. ”