NY Times article discusses palliative care

This is a must read.  Excerpt:

Most doctors do not excel at delivering bad news, decades of studiesshow, if only because it goes against their training to save lives, notend them. But Dr. O’Mahony, who works at Montefiore Medical Centerin the Bronx, belongs to a class of doctors, known as palliative carespecialists, who have made death their life’s work. They study how todeliver bad news, and they do it again and again. They know secretslike who, as a rule, takes it better. They know who is more likely tosuffer silently, and when is the best time to suggest ado-not-resuscitate order.

Palliative care has become a recognizedsubspecialty, with fellowships, hospital departments and medical schoolcourses aimed at managing patients’ last months. It has also become afocus of attacks on plans to overhaul the nation’s medical system, withfalse but persistent rumors that the government will set up “deathpanels” to decide who deserves treatment. Many physicians dismiss thesecomplaints as an absurd caricature of what palliative medicine is allabout.

Still, as an aging population wrangles with how togracefully face the certainty of death, the moral and economicquestions presented by palliative care are unavoidable: How much do wewant, and need, to know about the inevitable? Is the withholding ofheroic treatment a blessing, a rationing of medical care or a steptoward euthanasia?

A third of Medicarespending goes to patients with chronic illness in their last two yearsof life; the elderly, who receive much of this care, are a hugepolitical constituency. Does calling on one more team of specialists atthe end of a long and final hospital stay reduce this spending, or addanother cost to already bloated medical bills?

Dr. O’Mahony andother palliative care specialists often talk about wanting to curb theexcesses of the medical machine, about their disillusionment overseeing patients whose bodies and spirits had been broken by thetreatment they had hoped would cure them. But their intention, in ayear observing their intimate daily interactions with patients, was notto limit people’s choices or speed them toward death.

Read all:  http://www.nytimes.com/2009/08/20/health/20doctors.html