Palliative care

Palliative care has been defined as care that seeks to prevent, relieve, reduce, or soothe the symptoms produced by serious medical conditions or their treatment, and to maintain patients' quality of life. Ideally it is a part of the treatment plan from diagnosis on, but if it is considered an alternative rather than supplement to curative medical interventions and identified only with end-of-life treatment it can pose ethical dilemmas to physicians and families. If it is necessary to accept that death is imminent for a child with a life-threatening or chronic illness, introducing palliative care might be seen as a decision to “abandon hope” and thus may be resisted, both by families and by caregivers who have an emotional stake in the success of their treatment, risking undertreatment of pain and inadequate communication and discharge planning.

In the USA this bifurcation is resisted by considering palliative care to include end-of-life care planning and inpatient or outpatient hospice care, as well as pain management, but there are reimbursement obstacles as well as conceptual ones that make it difficult to more tightly integrate palliative care with mainstream medical therapies. As a result, palliative care is more likely to be a focus in children with terminal illnesses than in children facing chronic or life-threatening illness. It is to be hoped that the growing presence of multidisciplinary palliative care programs in US hospitals, as well as increasing emphasis on pain control and end-of-life care in medical education, will eventually mitigate this compartmentalization and bring the USA more in line with standard practices elsewhere.