The challenge of palliative care

Palliative care is patient-centered, rather than disease-focused; accepts the inevitability of death while simultaneously is life-affirming; addresses psychological, social, and spiritual concerns as well as physical ones; and is best delivered by a multiprofessional team working in partnership with patients and their families. Palliative care stresses the importance of "appropriate treatment" and the need for doctors not to prescribe a lingering death. Even though there is no chance of cure, there is much scope for psychosocial and spiritual healing, and often some scope for physical rehabilitation. Palliative care is emotionally demanding for professional carers, and strategies for personal support are necessary. The World Health Organization has played a major part in the ongoing campaign to improve cancer pain management and to make medicinal morphine more widely available. A systematic approach to pain and symptom management is essential, and there is need for specific training for all health professionals. In most countries, for palliative care to take root, there is need for a charismatic "champion". However, for palliative care to flourish, there is need for a governmental commitment to its development. Charisma continues to be necessary to prevent palliative care being strangled by an over-rigid bureaucracy, but incorporation into existing health delivery systems is necessary to prevent it being stillborn through lack of resources.