A Better Approach
A living room teeming with a military veteran’s agony and
anger, so thick a family could hardly speak until the pain
was managed. A newborn destined to die in minutes on his
mother’s chest, living an unthinkable year with dignity and
meaning. A high school hockey player with cancer, able to
return to taste his senior year because after six months of
pain he found relief.
Hospice and palliative care doctors live the details of their
patients’ lives. Palliative comes from the Latin word for “to
cloak,” and the goal of the specialty is to surround patients
suffering serious illness in an atmosphere of hope and care.
This is done by managing pain and other symptoms, listening to their questions and wishes, and helping patients and
their families navigate the scary, unknown waters of serious
or terminal illness. Palliative care often is provided by a team
that includes a physician specialist, nurse, social worker and
chaplain. It’s considered hospice when that care is given in
the last year of life, when curative measures have ended.
AAHPM President Sean Morrison’s path to palliative medicine veered down the heart of New York City and the AIDS
epidemic.
“What I saw day in and day out was a large amount of
untreated suffering — intolerable symptoms, tremendous
difficulty making decisions and, for older adults, a lack of
attention to multiple chronic diseases,” says Morrison, a doc-
tor and professor of geriatrics and palliative medicine at New
York’s Mount Sinai School of Medicine. “I had four years of
medical training and no idea how to really treat someone’s
pain. I thought, ‘There has to be a better approach.’”
The hospice movement began in England with the work
of Dame Cicely Saunders, who established the first purpose-built hospice in 1967 to cater to the physical, social, psychological and spiritual needs of seriously ill patients and their
families and friends. The palliative care movement came to
the United States about two decades later. Saunders’ ideas
were spreading. People were living longer with serious and
chronic illness. The battle over assisted suicide raged, many
desperate for an option between intolerable symptoms and
death. And doctors were beginning to see cancer as a disease
affecting the whole person, not just a body part.
A handful of palliative care programs took root in the
United States in the late 1980s, giving credence to the idea
that addressing quality-of-life issues doesn’t mean giving up.
And it can mean living longer.
That handful of programs has become 1,400 hospital-based palliative care programs. More than 80 percent of
hospitals that offer more than 300 beds now have a palliative care team. Hospice and palliative care became a board-certified subspecialty in 2008. The 22-year-old AAHPM has
tripled its membership in the last decade, and doubled it
in the last five years. And a 2010 study in The New England Journal of Medicine reported that lung cancer patients
receiving early palliative care experienced less depression,
increased quality of life and survived 2. 7 months longer than
those receiving standard oncologic care. Palliative doctors are
eager to spread the word, and their work.
“There’s so much about living and life that’s not medi-
cal,” says Jeanne Lewandowski, a physician and academy
member who runs the largest pediatric palliative care program
in Michigan. “We want a person to live as long as they can.
But really good palliative care is celebrating the life of the
individual, no matter how short it might be. Completing rela-
tionships, being with each other, forgiving… you can’t do that
if you are in pain all the time. If we take care of those symp-
toms, people can take care of things on a different level.”
People whose quality of life could be bolstered by pallia-
tive care often don’t know what it is. “It’s a public relations
issue for us,” says AAHPM Executive Vice President Porter
Storey, a palliative care pioneer who sees patients at two Col-
orado hospitals. “Forty percent of Americans die in a hospice
program. But people think of hospice as being for your last
three hours. They miss out on all we can do for them.
“I directed a large hospice in Houston for nearly 20 years,
and I heard over and over again from people who had suffered for months, came to hospice and felt better in two
days. They’d ask, ‘Why didn’t someone do this for me months
ago?’”
About AAHPM
The American Academy of Hospice and Palliative Care is the professional organization of more than 4,000 physicians
and other providers who dedicate themselves to caring for those with serious or life-threatening illnesses and their families. AAHPM’s nine employees and $4.2 million budget are focused on expanding access to palliative care and advancing
the discipline through professional training, development of a specialist workforce and support for clinical standards,
research and public policy.
