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Dr Jerry Old
Jerry Old MD is chief consulting medical officer with Hospice Care of Kansas and an associate professor at the University of Kansas School of Medicine-Wichita. He is a nationally recognized author and speaker on end-of-life issues. You may contact Dr. Old by phone at 1-800-HOSPICE.
Hospice
2008-12-01 14:19:00
What is aggressive care?
ANSWER: We are reaching a point in modern medicine where the concept of “Aggressive Care” at the end-of-life needs to be re-defined. When we think of aggressive medical care, we often think of all the amazing technology that can be used to prolong “life” in the 21st century. However, Hospice care, while usually seen as opposite of “aggressive care,” is in reality also aggressive care. The modern Hospice movement, while recognizing the futility of life support and ineffective therapies at the end-of-life, is not “No Care.” It is often more care—more aggressive pain management, more aggressive symptom management, insistent wound care, and more aggressive “quality of life” care. Thirty years ago when I was in Medical School, Hospice was seen as “alternative medicine.” I remember one of my professor’s great concern about the group of renegade hospice nurses going around giving people morphine! Now, with the creation of the newest medical specialty of Hospice and Palliative Medicine in 2006, Hospice has become standard of care—a very fast transition for the medical field. Little wonder its purpose is still frequently misunderstood. Hospice care and aggressive care are not opposites. The goals are just different. The goal in Hospice is neither to cure the disease nor to extend life expectancy beyond all reason. With hospice, the goals become things such as preservation of dignity, allowing the patient to maintain control, to stay at home, and recognizing the importance of treating emotional and spiritual suffering. It is helping patients and families through one of the greatest times of change and personal growth they will ever experience on this planet. Sounds like pretty aggressive care doesn’t it! The word “palliative care” literally means “to cloak” or surround the patient with caring. Even the term “comfort care” comes from the Latin “Com Forte” or to “care with strength.” A recent study has shown that people with similar medical conditions enrolled on hospice in a timely manner, actually lived LONGER than their counterparts who continued the traditional aggressive treatments such as chemotherapy or high risk surgeries and procedures. Most of us have heard of the “DNR” (Do Not Resuscitate) order that can be placed on a patient’s chart. The general interpretation of this order is that it means to do “nothing” medically for the patient. I much prefer the newer term “AND” which stands for “Allow Natural Death.” DNR is negative—do not do things! “AND” is much more positive—it implies allowing a natural process, but being active about it by aggressively keeping the patient comfortable in all ways possible. We must recognize that “Aggressive Hospice care” is not an oxymoron! Payment sources will continue to divide aggressive and non aggressive medical therapies, but medically and realistically, that line is becoming less and less clear. We thank all those dedicated hospice employees and volunteers at Hospice Care of Kansas and the nearly 70 hospices across the state for the “Aggressive Hospice Care” that they are providing to their patients and families.
 
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