Way back in the 1980s it dawned on me that as a soon-to-be family doctor it might be wise to know a thing or two about Palliative Care. It seemed reasonable that I should know how to alleviate the suffering of my patients from various end stage illnesses. So I took a two week elective.
The hospital I trained at in Alberta in 1986 happened to have a palliative program and I learned about hypodermoclysis and the like. I also learned about the staggering ability of the human body even when it is failing to tolerate ever increasing amounts of narcotics.
It was a serious topic for an elective but the staffperson in charge of the unit was a bright soul and the patients were always grateful. Physicians at the hospital knew their loved ones would get good care there. Unfortunately, the program was shut down several years later....perhaps a victim of its own success or perhaps because of the optics of having the beds filled with mostly "MD relatives".
Over my medical career I discovered that my skills in this area were not needed. The hospitals had Palliative Care teams and patients did not die at home for the most part. If that was the wish of the family there were Palliative Care MDs who would provide this service. I never did use the hypodermoclysis procedure but I did use lots of empathy.
In any case, the resurgence in interest in Palliative Care is driven not only by demographics but also by the Right To Die movement along with the Supreme Court of Canada ruling on Physician Assisted Suicide.
As hospitals are overwhelmed with Alternate Level of Care patients, the concept of patients dying at home has taken on new zeal and while the Feds plead for more time to come up with some kind of legislation to solve the murky areas surrounding PAS I wonder if legislation will ever come to be just as there is currently no legislation for abortion.
I do believe that more access to robust palliative care can be a real solution to alleviating suffering of patients rather than resorting to Physician Assisted Suicide. More training of family doctors will be required and more funding for access will be needed.
It is worth noting that caring for patients in their homes is a relatively inefficient use of medical services. This access to care will require time and the skills of physicians. It will impact availability of health professionals for other areas of care. There will be trade-offs.
It is time to understand again what was understood thirty years ago. Palliative Care is an important part of compassionate care. Too bad it took so long.