February 4 Forum

Jeremy

Yeah, I think as Walt brought up (if many of us can remember): it was not that long ago that palliative care was only for people who had terminal cancer for the most part. That was its origin story.  So, there’s a lot of discussions around broadening palliative care. You just have to have a serious illness to qualify. Actually, they’ve broadened it again, which is you are eligible if you have or potentially could have a serious illness. Who gets to decide if it’s a serious illness—or a potential for serious illness.  Is it only the doctor who can declare eligibility?

So palliative care has been slowly advancing in its scope and its timeframe in a way that sounds very parallel to this discussion.  And oftentimes the resources only go for the very end and then slowly that science begins to broaden because we’re having discussions in our residency practice that really palliative care principles count way, way earlier.  And if it’s a self-defined potential serious illness, then the entire practice could be eligible. The framework of palliative care is quite beautiful and quite interprofessional.

And what we tend to do is we narrowly define it for a small population.  We vertically integrate enormous services where they get everything, social worker, all this for this for one percent of the population.  And then everybody else who needs it doesn’t get it because they don’t meet the definition.

So that’s a little bit of what I’m hearing with this Bill is that you’re broadening this to a far larger scale, which you could provide even regarding medical service to children. Because what service might reverse the adverse childhood events impact on children. The ACE issues are almost the exact same as what you’re bringing up. These issues concern supportive relationships, space for emotional growth, a safe environment, and social belonging. You’ve added legacy, financial planning, and the bucket list.  These are very important issues that aren’t addressed by many people—whether these issues relate to the care of children or to the care of the elderly.

Bill B

Yeah, there’s a woman I care about who passed away a short while ago. She was shot in the spine and was paralyzed for half her life. She became a very successful singer.  Her name was Wesla Whitfield. Wesla ended up saying, “I’ve run out of copes,” This is such a powerful statement. She had been coping for many years. but ran out of strategies to cope—or simply got tired of coping. I think her case is dramatic because of being paralyzed from the waist down for many years. However, I think there’s a universal theme here. I think for many people, like me and many others at this point in life, there is the pressing matter of finding and making use of appropriate coping strategies?  Do the strategies change as we grow older?  Do we run out of copes at some point?  What is late-life coping all about?

Gay

There is another thing I think about. Those of you who are MDs can help me out with this. There’s been major advances in palliative care and the definition of palliative care has expanded from terminal cancer to the possibility of serious illness. However, if you’ve got somebody doing palliative care, it’s not my understanding that their role is one of providing emotional support or talking about what you want to do with your finances, right?  This is an area to which I wasn’t privy when I lost my parents.  So, there’s still this gap.