In February 20011 Joanne Lynn, MD, discussed
the case of Mr M, a 47-year-old musician living for the previous 3 years with
a recurrence of advanced rectal carcinoma initially diagnosed 8 years ago.
At the time of the interviews with Mr M and his longtime partner, Ms L, an
interdisciplinary palliative care team had helped Mr M with pain control and
home services. An around-the-clock paid attendant supplemented volunteer help
from friends. Interviews with Mr M and his partner illuminated their frustrations
and distaste for the available hospice programs. His primary care physician
described the complicated care and treatment plans that had been suggested
and abandoned—including Mr M's enrollment and disenrollment from hospice
twice—as Mr M and Ms L came to terms with the close of Mr M's life.
Dr Lynn described the 4 necessities of treatment that Mr M's clinicians should
provide: (1) prevention and relief of symptoms, (2) assessment of treatments,
(3) advance planning and designation of a surrogate decision-maker, and (4)
preparation for the time near death. Dr Lynn further explored the process
of enrolling in hospice, and the need for changes in the organization and
financing of end-of-life care to better match the changing trajectories of
patients living with—and dying from—serious, chronic illness,
whether one with a short period of obvious decline (eg, cancer), a long-term
disability (eg, congestive heart failure), or a slowly dwindling course (eg,
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