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The enemy is suffering—not death
LETTER TO THE EDITOR
The Enemy Is Suffering—Not Death Dear Editor: I applaud James T. Cheatham’s remarks in his Guest Editorial1 regarding the dilemma in end of life care decisions. I was particularly interested in the barriers he mentioned regarding physicians administering appropriate medications to relieve pain. I too became incensed when given excuses for not controlling pain at the end of life or at any time during the life span. Fear of litigation and lack of knowledge are of little “comfort” to that patient and family. We must remember, however, that numerous barriers exist both in the health care community and in the public arena. The health care community has a responsibility to educate the public and our colleagues about the “why” and “how” of pain management and end of life care issues. We have established pain management as one of the top 5 priorities for our health care system. In addition, we have established representation with our affiliates, in an End of Life Care Coalition. We have dedicated personnel working on these issues, consulting with other team members, and working with patients and families to provide a more comprehensive approach to pain management. The program includes both inpatient and outpatient consultation, assessment, and management of all types of pain problems. Recently, during the Joint Commission for Accreditation of Healthcare Organizations visit, the surveyors were impressed with our progress. They recommended we consider identifying our program as a “Best Practice” site, so that others may benefit from our efforts. Yes, there are many challenges, barriers, and misconceptions about pain control, dying process, and advanced directives at the end of life. I hope Mr. Cheatham recognizes these issues are being addressed in his community.
MARSHA N. REHM, MSN Pain Management/Oncology University Health Systems of Eastern Carolina Greenville, North Carolina PII S0149-7944(00)00273-7
REFERENCE 1. Cheatham JT. The enemy is suffering—not death. Curr
Surg 56:473– 474.
REPLY Thank you for sharing your response to my Guest Editorial, “The enemy is suffering—not death,” in 56(9) of Current Surgery. My comments were addressed nationally, not locally, as your hospital is not mentioned. However, to say, as you infer, that your hospital is doing all it can is a bit arrogant. We can all do more. The articles below1,2 point to the national dilemma. The Health Law Forum sponsored by the Brody School of Medicine this fall will devote an entire session to these problems, and I suggest that you plan to attend. JAMES T. CHEATHAM Greenville, North Carolina PII S0149-7944(00)00305-6
REFERENCES 1. Grady D. Living wills often ignored. News and Observer
May 29, 2000:A1. 2. Preston TA. Facing death on your own terms. Newsweek
May 22, 2000:82.
CURRENT SURGERY • © 2000 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/00/$20.00 PII S0149-7944(00)00273-7
269
The Enemy Is Suffering—Not Death Dear Editor: I applaud James T. Cheatham’s remarks in his Guest Editorial1 regarding the dilemma in end of life care decisions. I was particularly interested in the barriers he mentioned regarding physicians administering appropriate medications to relieve pain. I too became incensed when given excuses for not controlling pain at the end of life or at any time during the life span. Fear of litigation and lack of knowledge are of little “comfort” to that patient and family. We must remember, however, that numerous barriers exist both in the health care community and in the public arena. The health care community has a responsibility to educate the public and our colleagues about the “why” and “how” of pain management and end of life care issues. We have established pain management as one of the top 5 priorities for our health care system. In addition, we have established representation with our affiliates, in an End of Life Care Coalition. We have dedicated personnel working on these issues, consulting with other team members, and working with patients and families to provide a more comprehensive approach to pain management. The program includes both inpatient and outpatient consultation, assessment, and management of all types of pain problems. Recently, during the Joint Commission for Accreditation of Healthcare Organizations visit, the surveyors were impressed with our progress. They recommended we consider identifying our program as a “Best Practice” site, so that others may benefit from our efforts. Yes, there are many challenges, barriers, and misconceptions about pain control, dying process, and advanced directives at the end of life. I hope Mr. Cheatham recognizes these issues are being addressed in his community.
MARSHA N. REHM, MSN Pain Management/Oncology University Health Systems of Eastern Carolina Greenville, North Carolina PII S0149-7944(00)00273-7
REFERENCE 1. Cheatham JT. The enemy is suffering—not death. Curr
Surg 56:473– 474.
REPLY Thank you for sharing your response to my Guest Editorial, “The enemy is suffering—not death,” in 56(9) of Current Surgery. My comments were addressed nationally, not locally, as your hospital is not mentioned. However, to say, as you infer, that your hospital is doing all it can is a bit arrogant. We can all do more. The articles below1,2 point to the national dilemma. The Health Law Forum sponsored by the Brody School of Medicine this fall will devote an entire session to these problems, and I suggest that you plan to attend. JAMES T. CHEATHAM Greenville, North Carolina PII S0149-7944(00)00305-6
REFERENCES 1. Grady D. Living wills often ignored. News and Observer
May 29, 2000:A1. 2. Preston TA. Facing death on your own terms. Newsweek
May 22, 2000:82.
CURRENT SURGERY • © 2000 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/00/$20.00 PII S0149-7944(00)00273-7
269