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Opening conversation of Care Toward the End of Life session asks what change is needed to improve palliative care
Where do we want to see the field of palliative care in ten years? This was the opening question at the Salzburg Global Seminar session Rethinking Care Toward the End of Life.
To consider where we want palliative care to be in ten years’ time, we need to first consider what the population will be like in ten years’ time, suggested one panelist on the opening panel, who together brought expertise from Australia, Rwanda, the UK and the US.
Many countries’ populations are aging rapidly. Co-morbidities are also on the rise as people suffer from more than one condition at a time. Both factors will place strain on existing health care systems. As another participant put it: We’ve become so successful at preventative and curative care, we now need to address palliative care and ensure that, as well as living a healthy life, we can also die a “healthy death.”
How can we have a good life and healthy death instead of a prolonged life and painful death? Society has become so fixated on living as long as possible that they have forgotten that dying is also part of life, remarked another panelist.
The stigma surrounding death needs to be tackled, much like the stigma surrounding HIV/AIDS has been. To do this we need a societal shift in attitudes. Society has proven it can profoundly change its behaviors in the past; that smoking would be such a societal taboo was unthinkable a generation ago.
How can we accomplish this shift? It will take both a top-down, policy-based approach, as well as bottom-up, grassroots engagement, with both ends demanding change in the current health care system. One must also not forget the health care professionals in between these two approaches. “We need doctors who can talk about death,” said one participant, rather than induce fear. Palliative care is too often an add-on rather than central to a dying patient’s care. Engaging palliative care doctors before oncologists, for example, may help to treat the whole patient.
Central to the debate on palliative care is the patient and their wants and needs. “I do not want others to have what I do not want to have,” said one panelist. In many countries, dying in hospital is a status symbol and proof of the value a family places on their loved one’s life. However, many people would prefer to die in comfort at home; families and doctors need to understand and meet the patient’s own preferences.
Achieving these societal and professional shifts is no small undertaking. The experts gathered in Salzburg this week have much to consider and debate.
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The Salzburg Global Seminar session Rethinking Care Toward the End of Life, part of the long-running series Health and Health Care Innovation, is being held in partnership with the Dartmouth Institute for Health Policy & Clinical Practice and the Mayo Clinic. Follow online on Twitter with the hashtag #SGShealth.