How can the issue of the expense of end-of-life care be addressed, in terms of money spent for curative therapy in the last days of a terminally ill patient’s life?

How can the issue of the expense of end-of-life care be addressed, in terms of money spent for curative therapy in the last days of a terminally ill patient’s life?

Palliative care is defined as an interprofessional team approach to “optimizing symptom management and quality of life for those with serious or life-threatening illnesses.” It emphasizes the importance of caring for not only for a person’s physical needs, but also the psychosocial and spiritual needs of the patient and their family, paying respect to and understanding of patient preferences and cultural beliefs. Palliative care begins when a terminal illness is diagnosed, and it can include provision of curative therapies, along with therapies to maintain a patient’s physical comfort. It is important to distinguish palliative care from hospice care, which involves care of a patient in the final months of an incurable disease. The goal of hospice care is to recognize dying as a normal part of the life cycle and help maintain a person’s quality of life at the end of their life; it does not include the provision of curative therapy. 1
In order to prevent physical suffering at the end of life (in either palliative or hospice care), symptoms such as pain, delirium, nausea and vomiting, and dyspnea must be managed aggressively. In people with intractable symptoms, palliative sedation with phenobarbital, propofol or midazolam can be considered. Initiation of controlled sedation must be discussed openly with the patient’s family so that it is clear that the sedation is being used to provide symptom relief, and not as a way to hasten death. A study confirmed that palliative sedation, even when up-titrated, did not hasten death. 1
Equally important is the management of spiritual pain. Dying people may have feelings of abandonment, anger, betrayal, despair, fear, guilt, meaninglessness, regret, self-pity or remorse. Hospice care providers specialize in helping patients and their families deal with these feelings. 1

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