June 11, 2018

Choosing Comfort Care

When Barbara Bush made the decision to pursue comfort care rather than treatment, it highlighted a choice often misunderstood.  The words “comfort care” tend to evoke a visceral response of fear – that one is giving up and walking away from medical intervention.  People often feel “comfort care” represents the end of aggressive care and modern medicine. 

To the contrary, nothing could be further from truth.  When people choose comfort care, they are proactively choosing to take hold of the living they have left.  It is a choice to pursue aggressive medical interventions all aimed at one thing—to amplify quality of life. 

They are choosing aggressive measures toward symptom and disease management consistent with their goals of care, all aimed at what they hold most sacred.  For many, one of those sacred goals is quality time with family at home. 

It just so happens that an unexpected side effect of the comfort care choice is often a longer life – a finding backed up by research.  Many find it perplexing and counterintuitive to hear that the pursuit of comfort correlates with more time to live.  I often find myself at a bedside with surprised family members when their loved one seems to have improved since leaving the hospital and receiving hospice care.  What I tell them is, just because you can try something medically does not mean you should, and just because something might help, does not mean it will. 

Aggressive life-sustaining measures for someone with a chronic and serious illness are often very invasive and risky, with the odds far in favor of failure rather than success.  Pursuing such measures can lead to increased time in the hospital, lack of sleep and good nutrition, and exposure to high-risk procedures, tests and potential complications.  Such measures often lead to increased discomfort and suffering and likewise detract from quality time with family. 

Barbara Bush’s choice reminds us that modern medicine and comfort care are not mutually exclusive.   We all pursue medical care to optimize our living.  We should hold these goals even more sacred when we are dying.