|Dr. Paul McIntyre is working with the QEII Foundation to raise money for the Endowed Research Chair in Palliative Care. (Contributed)
A strong measure of society is how we treat the most vulnerable among us. The way we care for each other during terminal illness, and at the end of our lives, impacts not only those who are ill but also their loved ones. Arguably, the quality of this treatment permeates society as a whole.
Demographically, we are living longer as a population. This, together with healthcare advances allowing for an increase in the number of people living with chronic illnesses, warrants the need for practical research to discover how best to help patients and families facing death.
Currently, the QEII Foundation is working with the Capital Health Palliative Care Service to raise funds for an Endowed Research Chair in Palliative Care. Once funded, this position will explore innovative ways to achieve comfort, ensure respect and enhance support for Atlantic Canadian patients, and families, coping with terminal illness.
Dr. David Currow is an internationally-recognized expert in palliative care research from New South Wales, Australia. Recently Dr. Currow visited Dalhousie University and the QEII, to speak about the importance of focusing on terminal illness and palliative care.
Dr. Currow, along with Dr. Paul McIntyre, Chief of the Division of Palliative Medicine at Capital Health, was able to provide both a local, and international, perspective on the impact and significance of palliative care in terms of both the patient and those who care for them.
Palliative care is where ethics, science and, according to Dr. Currow, art, intersect.
“There are many definitions of palliative care, such as the assistive response to helping individuals and the families of individuals who have advanced, progressive illness from which they are expected to die,” explains the renowned Australian researcher.
“However, this doesn’t quite capture it. For me, palliative care is about the art of the possible.”
According to Dr. Currow, palliative care is about paying attention to bereaved family members and their experience. It involves quality of life, planning and trying to ensure the healthcare system is responding to needs in the right way across care settings — in the home, hospital or nursing home. It also crosses care providers — family, nurses, doctors, volunteers and others.
“The emphasis is so easily limited to terminal care — the hours and days before death and pain control,” says Dr. Currow. “But this is about optimizing the psychological, physiological and the emotional. It’s not a disease-specific approach — but patient centered, in a holistic and individual way.”
This subtlety and balance is what makes the process an art as well as a medical service.
Palliative Caring in Halifax: a local perspective
Dr. McIntyre came along early in the palliative care movement in Halifax.
“I became inspired by not only the intellectual challenge, but by the privilege of involvement in the relationships. Palliative care is a very rich experience — not an easy one,” says Dr. McIntyre.
“I learned a lot from the nurses and was interested in participating on a team of complementary roles. I didn’t know it at the time but it was the beginning of my palliative care career.”
Dr. McIntyre admires the team-based nature of it. His research, however, takes the discipline to another level, asking how we can realize the possibilities and how to prioritize as life comes to an end. It is about the complexity of assisting and enhancing the experience of the inevitable.
“In regard to end-of-life care, much like the emperor, the doctor has no clothes,” says Dr. McIntyre. “Many of us became doctors because we have a desire to ‘fix’ things. Palliative care doesn’t involve a fix as such. In this way it creates a kind of mutual vulnerability that’s very compelling to me as a researcher and a physician.”
“It’s a complex and emotionally challenging environment,” adds Dr. Currow. “Patients, family and medical care — all working in the realm of the psychological, physical and spiritual. We need to consider what best practice is, how best to treat pain and the best ways to assist care givers so they remain healthy.”
Dr. McIntyre believes the proposed QEII Foundation Endowed Research Chair in Palliative Care would not only help to answer these questions, but also allow for research in how best to invest money into the system in terms of the delivery of care. Dr. Currow agrees.
“More research into this field is essential,” says Dr. Currow. “The community’s expectations are rapidly increasing. What was acceptable 20 or 30 years ago is no longer deemed so. The thought that we have the ability to keep people alive longer necessitates new thought into the end-of-life process.”
Dr. McIntyre explains that acknowledging death is the common ground of healing. We need to help each other.
According to Dr. McIntyre, “there’s a price to pay for staving off the acknowledgment of dying. Instead we need to ensure they can make the most use of that time. It truly is the art of the possible.”