Indian Journal of Palliative Care
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Year : 2007  |  Volume : 13  |  Issue : 1  |  Page : 17-18

A lifetime in palliative care

Director Palliative Care Services, Barbara Ziegler Palliative Care Program of the North Broward Hospital District, Florida and Medical Director, Gold Coast Hospice, USA

Correspondence Address:
Pamela Sutton
Director Palliative Care Services, Barbara Ziegler Palliative Care Program, North Broward Hospital District, Ft. Lauderdale, Fl. 33316
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1075.37186

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How to cite this article:
Sutton P. A lifetime in palliative care. Indian J Palliat Care 2007;13:17-8

How to cite this URL:
Sutton P. A lifetime in palliative care. Indian J Palliat Care [serial online] 2007 [cited 2020 Feb 26];13:17-8. Available from:

Nearly 30 years ago, I drove into Fort Lauderdale, Florida, to help start a hospice program. At that time in the United States few people knew what hospice was. Neither did I. All I knew was that I was Board Certified in Family Practice and unhappy with high-volume medicine and with the way I had treated dying people. My colleagues and I had no end-of-life care training. In fact, Dr. Kubler Ross wrote On Death and Dying to help our medical establishment admit that we actually did have dying people in our hospitals. Hospice sounded like something I could feel good about. It meant I could take time to listen to patients and families and try to make them comfortable. Wasn't that a big part of why we became doctors? Somehow it had gotten lost in the relentless drumbeat to cure.

For me, hospice was an awakening. The literature warned, however, not to get too comfortable because eventually palliative care physicians such as myself might do ourselves out of a job as all medical practitioners embraced palliative care. Well, it didn't happen. Thirty years into the hospice movement in the USA may be 80% of patients die without the help of hospices, and many cancer patients still die in pain. This sentence can also be said the other way: Now about 20% of Americans have comfort from hospice at the end of their lives and a lot of cancer patients do have appropriate pain management! And, although everywhere we turn, there are more machines and intensive care unit beds, increasingly there are also more palliative care teams insisting on comfort, walking alongside patients as they chase the all-too-elusive cures.

What about the rest of the world? Not everyone has multiple medical options. Over the years, I have travelled and worked in countries with limited resources and no lack of pain. I was struck by a story about a woman in Vellore, India, who had to work outside the house to feed her two healthy children even though it meant that her third sick child would die for lack of her attention. Such deep poverty is bone-chilling. Apparently the medical care system could not save that child's life. Could it have at least provided comfort? One thinks of the pictures of Mother Theresa holding the dying, of the love and the spiritual solace. In addition, palliative professionals know that physical comfort should be provided to everyone.

In 1988, I had the privilege of working at the Gujarat Cancer and Research Institute in Ahmedabad, India, with Dr. Mohan Bhatia. He had an abiding interest in relieving cancer pain and had received temporary permission from the government to give opium in tea to cancer patients. He also had a small supply of oral morphine for cancer pain. The relief and the results were significant! It was a start in raising awareness about what could be done to make patients more comfortable.

That was already almost 20 years ago. India has come a long way with palliative care. There has been significant progress. Undoubtedly, there have also been setbacks and disappointments. There is a fog of resistance all over the world about the use of opioids for cancer pain. Everyday in USA, I have to deal with misconceptions and resistance from medical practitioners, patients, pharmacists and the public about the use of opioids for pain. The resistance is even greater elsewhere. But, we are making progress. Practitioners of palliative care need to remember that they are doing what is right and that they are not alone.

In 1991, I had spent a month in Pakistan as a WHO consultant in Palliative Care. I spoke to groups of doctors in seven cities. I also spoke to the government about making opioids available for cancer pain. The doctors were then ready for palliative medications to be made available, but apparently little changed. Recently, I revisited Lahore as a private citizen and became reacquainted with a radiotherapist I had met earlier in 1991. He expressed much frustration with his attempts to introduce palliative care into medical practice locally. In an effort to help him, I had sent an email to David Joranson, who is well versed in governmental issues regarding medicine availability throughout the world. He in turn sent out more emails, and a flurry of responses came back to the doctor in Lahore.

It turns out something has changed! The internet brings the palliative community to the practitioner's door now. Now this palliative physician is not alone, but has a network helping him!

In summary, the palliative community is growing and spreading, and the world is changing gradually. Progress may seem slow, but while the political world snarls across borders, palliative professionals are bringing comfort. We must not give up, because little by little palliative care is spreading. Palliative care is making life better one case at a time.


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