Doctors urged to be frank about advanced cancer patients’ odds, to help plan end-of-life care –

Doctors urged to be frank about advanced cancer patients’ odds, to help plan end-of-life care –

The gist of this article is that oncologists are being encouraged to have conversations with patients about their treatments options, including the foregoing of aggressive treatments and just the provision of comfort, palliative measures.  A few quotes:

Patients don’t want to hear that they’re dying and doctors don’t want to tell them. But new guidance for the nation’s cancer specialists says they should be upfront and do it far sooner.

The American Society of Clinical Oncology says too often, patients aren’t told about options like comfort care or even that their chemo has become futile until the bitter end…

“This is a clarion call for oncologists . to take the lead in curtailing the use of ineffective therapy and ensuring a focus on palliative care and relief of symptoms throughout the course of illness,” the guidance stresses.

But it’s part of a slowly growing movement to deal with a subject so taboo that Congress’ attempt to give such planning a nudge in 2009 degenerated into charges of “death panels.”…

“There is going to be, over the next few years, a groundswell of people telling physicians, ‘I don’t want to go out in excruciating pain, short of breath, alone, surrounded by lights and sirens and people pounding on my chest,'” predicts Dr. Jonathan Weinkle, a primary care physician who advises the program.

“Everybody wants a good death but not a moment too soon, but they don’t have the language to ask for it…”

There is a general fear of planning for our end-of-life needs.  We often struggle with the recognition of the existence of death, and even for those who have accepted that death is inevitable, when facing one’s mortality, there is often an increased desire to avoid the topic.  People believe that if talking about death is avoided, then death won’t happen. 

As a Hospice chaplain, I often meet people who, even once they have decided on palliative Hospice care, still will not discuss their wishes out fear of depressing themselves or their loved ones.  While this is to be respected, I get the sense that a frank conversation would be of emotional benefit, and that the long term benefit would outweigh the short term verbalization of the person accepting his/her mortality.  Additionally, by the conversation being held with one’s physician, it could create a different dynamic that would be beneficial for the dying person.  Studies have suggested that people still have greater trust in their physicians, more so than for friends and family who offer advice.

Palliative Care Conversation | The Book of Doctrines and Opinions:

Palliative Care Conversation | The Book of Doctrines and Opinions:.

Here is my first response to this post:

In terms of the issue of Chabad and there interest in palliative care, at their shluchim convention this year, my father, the chief medical officer of the largest hospice in the US, gave a lecture on Jewish medical ethics at the end of life. From what he told me, it was well received. Chabad tends to be the most engaged in this subject due to their being widespread and encountering more diverse types of Jews as congregants. It is possible that this other lecture was similar in scope to the one at their shluchim convention. My father has also lectured this past year at the Talmudic University in Miami, better known as R’ Zweig’s Yeshiva.

Regarding the issue of Rabbis acting as doctors instead of pastoral counselors, this is one the greatest challenges I face as a chaplain. While an Orthodox rabbi, I find myself at times in the pastoral role instead of their own rabbi, who is more worried that the hospice is out to kill the person instead of caring for them in a palliative manner. In my area, I am beginning to work with the community rabbis to find a common ground to make them more hospice friendly while also being flexible with what hospice provides under the rubric of comfort care.

I remember hearing R. Tendler years ago say that all Rabbis need an extensive background in biology so as to be able to better deal with the specifics of the myriad of medical issues congregants face. The problem is that these same rabbis then believe they know the medicine enough to then make decisions with consulting with the medical authorities. Unfortunately, this often leaves the hospice in the lurch, because if the hospice suggests an intervention is harmful, there is that same sense that hospice is there to end life sooner. Much of this fear is old, but it also gets spurned on by current events and how they are misunderstood, such as Terry Schiavo’s case. With that said, what people don’t realize is how comfort care, palliative care/hospice care, can often prolong life and provide a better life as one comes to the end.

Re: Israel and palliative care – Palliative care as a means of comfort care for the dying exists in Israel. The model is different than the American one in that they do not utilize chaplaincy. Most of the palliative care groups believe that Social Worker can provide spiritual support in addition to psycho-social support. While there is some truth to that, the lack of chaplaincy is more due to the perceived dati/hiloni divide and a lack of funding than to a sense of territorialness. Additionally, the question of chaplaincy qualifications is a hot button item because most people training to be spiritual care providers in the Israel system are non-Orthodox, thus leading to a whole set of other questions.