This poignant case illustrates some of the barriers to appropriate engagement of a palliative care team. The emergency medicine physician mistakenly equated palliative care with giving up hope. However, hope is not lost when we approach the limits of medical science’s capacity to cure disease and prolong life. Rather, that is the time we can give hope to the patient and family through palliative care, which focuses on quality-of-life needs, symptom control, psychological support, and caregiver support.
Palliative care would have been an opportunity to offer comfort and hope to Bonnie and her family. A palliative care team would have been comfortable with and sensitive to the deep distress felt by Bonnie’s children. Their experience in communication and family dynamics could have helped the family reach consensus on a plan that best met Bonnie's needs, grounded in an understanding of prognosis and benefits and risks of treatment options. Their assistance with symptom control would have given the family confidence that the medical team was doing everything possible to care for and help Bonnie. The request for palliative care was a cry for hope. It needs to be answered more often.
Covinsky KE. Palliative Care = Hope. JAMA Intern Med. 2014;174(1):14. doi:10.1001/jamainternmed.2013.9309