Home Health Care Participates in the 2011 Palliative Care Symposium

Dr. Davis also reminded physicians that there will be families who have unrealistic expectations, some of which modern medicine can not meet. Under such pressure, doctors should know how to respond.

In her lecture, Dr. Ghauri Aggarwal, the Head of Concord Hospital’s Palliative Care Department in Australia, brought up ethical issues surrounding the decision-making process in advanced diseases. The balance between beneficence, or doing good, and non-maleficence, or doing no harm, was highlighted.

Dr. Aggarwal then brought to light the many ethical pitfalls of practicing medicine and caring for patients with life-limiting illnesses. She discussed several situations and asked the crowd to participate in the decision-making process.

Ethics has always been an area of controversy, because the same principles may yield different decisions based on personal interpretation, cultural influences, external pressures, and religious beliefs. Ideally, this should not be the case; however, it is the principles that remain absolute – and the supposedly ethical conclusions are still a matter of argument.

Patients and their relatives often fight death, even when it is inevitable. Whatever time that remains is wasted on futile efforts to prolong the dying process. “Physicians, in their desire to be patient advocates, sometimes forget to practice medical restraint,” Dr. Aggarwal said.

“Palliative care is about empowering a patient,” Dr. Aggarwal explained. It is through palliative care that a patient accepts and adapts to death, thus giving him the opportunity to make the most of his life.
The scope of palliative care includes knowing when to withhold treatment, especially when such a treatment is futile. “The use of a ventilator when a patient has already reached the stage of dying should be withheld, especially if that aggressive step will not improve his quality of life,” added Dr. Aggarwal.

Without sugar coating the truth, Dr. Aggarwal laid down the cards, explaining the importance of palliative care and of medical restraint. “People die. Our job is to determine if treatment is futile, and if it is, we do not offer it,” she said with finality. “We do not have to preserve life at all costs.”

During the symposium, Dr. Aggarwal advised the doctors to always do an end-of-life discussion with dying patients. The dying process has to be discussed, she said. “Always discuss the answer to the question, ‘How does one die?’”

Several physicians responded to Dr. Aggarwal’s lecture, saying that the Philippine setting is not ready for the changes dictated by palliative care practices, especially when it came to withholding resuscitation.

Dr. Maria Fidelis Manalo, the Head of the Cancer Center’s Palliative Care Unit at the Medical City, voiced her concerns on the issue of cultural sensitivity. “Hospital and palliative care is relatively young in the Philippines, having started just last 2002 at UP-PGH,” she shared. “In the Philippines, the decision to withhold resuscitation lies in the hands of the patient or, if he is not competent, in his relatives.”

Perhaps it is just a matter of time before the Filipino culture started to embrace palliative care as a wonderful addition to the country’s medical armamentarium. “The pendulum has swung. It has swung to one end where we want to play God, where we don’t want anyone to die,” Dr. Aggarwal said. “But it will eventually swing back in the opposite direction where we will focus on the art of medicine, on providing the best possible care, wherein death is a reality.”

Home Health Care provides hospice and palliative care and is one of the leading institutions of palliative care in the country. Home Health Care helps patients with life-limiting illnesses, actively providing comfort and care to both the patient and his family. A nursing home and assisted living facility are also available.

At Home Health Care, the doors are open twenty-four hours a day, seven hours a week. To know more about how Home Health Care can help you, contact them through their hotline, 9201445.