dylan thomas … & the palliative care box …

… MacAuley’s excellent essay on “Patients who make ‘wrong’ choices” …

”Ironically, for all of palliative care’s talk of total suffering, we may be unwilling to accept that a patient’s emotional suffering over choosing a palliative course of treatment may be more severe than eventual projected physical suffering from an aggressive course … In the end, if we are brutally honest with ourselves, we must recognize that palliative care is as value-laden as any other specialty. Beyond our stated principles of autonomy and beneficence lie tacit assumptions that are not universally shared, such as that life should not be preserved at all costs, and that the best response to terminal illness is peacemaking. Only when we encounter ‘‘good men, the last wave by, crying how bright their frail deeds might have danced in a green bay,’’ can we see full well that our assumptions are biases commonly (though not universally) held, and, as such, can impair our ability to provide whole person care by honoring a patient’s heart-felt wishes.”

(dylan thomas’ poem here)