Palliative care and quality of life

(Second of four parts)

Last week, we saw how good palliative care enhanced the quality of life for businessman Dennis Ang, who died of liver cancer less than a year after diagnosis.

Prior to his death, he was able to talk tenderly with loved ones, prepare himself emotionally and spiritually, articulate his wishes about final measures. With supervised sedation and nutrition, he avoided extreme suffering, and remained at peace.

READ: Dying with dignity

Accompanying patients in pain and enabling them to “live life with good quality” is the mission of Dr. Maria Fidelis “Liza” C. Manalo, head of the section on Supportive and Palliative Care at The Medical City. (Note: She did not treat Dennis)

“In palliative care, we tell patients the pros and cons of measures, so they can make informed decisions, which we respect,” Manalo says.

Such decisions are never easy. “Patients do not want colostomy bags, but what if they cannot poop? They do not want tubes, but what if fluid [floods] the lungs and they cannot breathe? Patients need to know the reality, so they can make informed decisions.”

Manalo adds that many people equate palliation with “talk, talk,” but aside from psychosocial support, medicines are also used to control symptoms. (Note: As a clinical psychologist, I do therapy to help bolster mental health, but I cannot give pain medications to alleviate physical suffering.)

I tell Dr. Liza of family and friends who died in pain, which underlines the need for accessible pain medication plus competent and compassionate palliative care. The House recently passed the Medical Cannabis Act, but it is too early to discuss its effects on palliation. Instead, Manalo enumerates pain medications that have long been approved, such as oxycodone, which due to marketing problems, can no longer readily be found in the country; fentanyl, whose steep price makes it unaffordable for the majority poor.

There’s also morphine, the most famous opioid of all.

“Morphine is affordable but not easily accessible,” she says. The head of the World Hospice and Palliative Care Alliance suggested to her that we import morphine from India, with quality assurance put in place by the Food and Drug Administration of both India and the Philippines.

“Historically, opium comes from India,” says Manalo, who hopes government agencies can streamline procurement. Friends tell me of going to multiple pharmacies only to discover that medications are out of stock, while loved ones suffer in agony.

To government: Ensure that pain medications are at hand for those who truly need them.

When I bemoan the dearth of hospices, Manalo says that in our culture, families prefer to care for loved ones at home—it is “unthinkable” to have them be managed by strangers.

A hospice stay also costs as much as a hospital, with 24/7 nursing care, medications, etc. In the past, some of Manalo’s colleagues attempted to put up a hospice enterprise, but there was “no buy-in” from society.

What works is the home hospice, experienced by Dennis and his family. Nurses rotate in shifts, doctors monitor patient care through chat groups. Hospice at home is still not cheap, but Dennis’ wife Ramona said that the flexibility and comfort of staying at home rather than in a hospital was a blessing.

Manalo talks wistfully about palliative care doctors who do home visits in Japan, where advances in technology, plus societal support, enable them to, for example, use portable ultrasounds to remove fluids from the stomach. Here, because these machines are extremely pricey, doctors who visit homes do without such aid.

To businesses: Include palliation in your philanthropy.

Palliative care is not just for those near the end of life, but for anyone in pain—heart disease, dementia, spinal issues, etc. Only 70 palliative care doctors exist in the country.

“We treat life-limiting diseases, so the practice is not lucrative,” Manalo says. “Suffering and death also take a toll on doctors.”

In a society ubiquitous with suffering, palliative care is essential.

(Next week: Make every minute count)