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September 4, 2018

Ambiguity in End-of-Life Care Terminology—What Do We Mean by “Comfort Care?”

Author Affiliations
  • 1Section of Palliative Care, MedStar Washington Hospital Center, Washington, DC
  • 2University of Maryland School of Pharmacy, Baltimore
  • 3Department of Medicine, Georgetown University Medical Center, Washington, DC
JAMA Intern Med. Published online September 4, 2018. doi:10.1001/jamainternmed.2018.4291

“Don’t you think he looks comfortable right now?”

We stand quietly at the foot of the bed and watch. The patient lies semisupine in the mechanical bed, intermittently breathing slowly and deeply before longer apneic pauses. Despite the soft groan of the bilevel positive airway pressure machine and the occasional chirps from 4 continuous intravenous drips, he seems settled, arms open, hands unfolded to the fluorescent overhead lighting. Even in this state of unconsciousness, he seems to be preparing to die.

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    1 Comment for this article
    All care should focus on comfort
    Jan Bakker, MD, PhD | NYU Langone, New York

    A very nice paper by Anne Kelemen on the confusion about the use of comfort care in the US healthcare system. I think this problem relates to another problem, briefly touched by Anne: In the US we don't talk about dying. So a system of communication is developed to keep avoiding the real problem. Comfort Care is one of them and the term Comfort Measures Only doesn't improve this. The quote from the resident says it all. Instead of offering a more quiet peaceful room outside of the ICU to be with their dying father it was offered because the patient was receiving comfort care.

    By avoiding the real thing, we doctors are creating a problem that doesn't need to be. Comfort should be the aim of every treatment even if it is by definition uncomfortable. We have means to make every uncomfortable situation comfortable; that’s not the challenge. The challenge is to adequately walk with the patient and his or her loved ones to the end and not to distract them from the fact that he/she will not be anymore. I have seen a lot of valuable time wasted by distracting patients/families from what's really important by talking around dying. I think the general care of a patient is aimed at recovery and in that process the patients should be comfortable. It's not an easy road to walk with your patient but it's a core value of being a doctor as even in this phase you can assist in 'healing'.