At the crossroads of religion and palliative care in patients with dementia
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(2020) 9:43
COMMENTARY
Open Access
At the crossroads of religion and palliative care in patients with dementia Kieran L. Quinn1,2,3*
and Daphna L. Grossman4,5
Abstract The timing of palliative care initiation may be more appropriately directed using a needs-based approach, instead of a prognostically driven one. Jewish Law or Halachah (“the way”) upholds a strong commitment to the sanctity of life and teaches that the duty to prolong life supersedes the duty to end suffering prematurely, unless one is expected to imminently die. This intersection of palliative care and a reliance on prognostic triggers with an individual’s observance of religious traditions complicates matters nearing the end-of-life. A recent pilot study by Sternberg et al. of 20 patients with advanced dementia in Israel found that home hospice care significantly reduced distressing symptoms, caregiver burden and hospitalization and teaches us important lessons about some of the essential elements to providing excellent palliative care at home, including the 24/7 availability of healthcare providers outside of the emergency department. In light of specific religious practices, palliative care should strive to incorporate a patient’s specific religious observance as part of high-quality end-of-life care. Keywords: Dementia, Palliative care, Judaism Palliative care is an approach that focuses on the care of people who are suffering from serious illness with a goal of improving quality of life, reducing suffering and helping with decision making for them and their caregivers [1]. The timing of palliative care initiation may be more appropriately directed using a needs-based approach, instead of a prognostically driven one [2, 3]. In other words, palliative care should be delivered when someone is suffering with a serious illness and in need of care to relieve that suffering. It is easy to imagine that this may occur at any point along the disease trajectory independent of the timing of their death, including at the time of diagnosis [4]. However, the provision of palliative care services is often determined in the context of prognosis, with enhanced * Correspondence: [email protected] 1 Department of Medicine, Divisions of General Internal Medicine and Palliative Care, University of Toronto, Toronto, Canada 2 Department of Medicine, Sinai Health System and University Health Network, 60 Murray Street, 2nd Floor Room 404, Toronto, Ontario M5T 3L9, Canada Full list of author information is available at the end of the article
services offered as a person approaches end-of-life. “Trigger tools” or prognostication calculators have been developed to answer the question of how soon a person will die and therefore signal when palliative care should be instituted. There is increasing interest in the use of machine learning and artificial intelligence to more accurately determine a person’s prognosis [5, 6]. However, pinning our hopes on complex machines to predict complex events such as the timing of a person’s death in order to more accurate
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