Clinical Pearls

Balancing Comfort and Communication at the End of Life

Kevin Dieter, MD HMDC FAAHPM

The way in which care is given can touch the most hidden places.
—Dame Cicely Saunders

In the 1992 paper entitled “Palliative Medicine— Just Another Specialty?” Dr. Michael Kearney eloquently addressed the concern that our specialty would lose sight of the “compassionate loving care” foundation developed by Dame Cicely Saunders in the hospice model of care. He also cautioned that the prevailing medical model of care would lead to a specialty of “symptomatologists.” ¹ Underpinning his concern was the understanding that the pain and suffering of a dying person is not simply a set of symptoms to be managed medically but holds the potential for healing and transformation. He felt a focus on pharmacologically “curing the suffering” excludes the equally important role he described as requiring “midwifery skills.” He advocated for a specialty that involved a dual commitment, honing and using clinical skills and enabling patients and families to explore the possibility of healing embedded in their illness experience. Using the metaphor of palliative care physician as shaman, Dr. Kearney encouraged physicians to use their own woundedness to help heal others, themselves, and, in some respects, Western medicine generally.