April 19, 2018

Barbara Bush, ‘The Great Woman’ of Palliative Care

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She had chosen palliative care as the medical therapy.

EDITOR’S NOTE: Former First Lady Barbara Bush died Tuesday at age 92 at her home in Houston, having decided to decline further medical treatment for health problems and instead to focus on “comfort care.”

The ‘Great Man Theory’ of history was popularized by the Scottish author Thomas Carlyle in the mid-19th century. In his 1840 Lectures on Heroes he famously wrote, “The history of the world is the biography of great men.” Carlyle’s claim was that history was made by ‘great men’ possessing personal courage, vision, charisma, and political or military genius. Our more egalitarian age has favored mass movements, social forces, and ‘great ideas’ as the shapers of history. 

However, the ‘Great Man Theory’ of history was proven true this week by a ‘Great Woman.’ Palliative care, although excruciatingly important to medical care, has for decades struggled for a place at the table of medical specialties and in the medical consciences of physicians. This struggle for recognition was won this week when a ‘Great Woman’ possessing courage, vision, charisma, and humanity made palliative care history. Mrs. Barbara Bush told the world she was opting for “comfort care.”

In a media instant palliative care became the headline in every paper or electronic news forum and in the talking points of all talk radio. However, the first words of written news and initial voices of radio chatter revealed the painful prejudice that has kept palliative care as a second-class medical specialty by reporting that Mrs. Bush had chosen to “stop medical therapy.” The painful truth exposed by the former First Lady’s public decision is that in many places and for many physicians relief of suffering is not considered ‘medical therapy,’ in fact, very often it is not considered at all.

Subsequent reporting has reflected the seismic impact of this ‘Great Woman’s’ actions. Articles are now reflecting the glare from the light Mrs. Bush’s choice has shone into the dark side of sickness – the side of medicine where care is only prolonging life without restoring a life, where treatment only delays the dying descent of a disease, where suffering is often ignored by doctors and endured by patients. The courage, vision, and humanity of Barbara Bush was to publicly stop just preventing her death and to live her life until her death arrives. She had chosen palliative care as the ‘medical therapy’ for the heart and lung diseases that have mastered her body.

We are witnesses to the actions of a ‘Great Woman’. Before Mrs. Bush’s announcement a Google search of ‘palliative care’ produced over 1.2 million results but patients by the millions are going without palliation of their suffering. A search today of ‘Barbara Bush Palliative Care’ has already reached over 233,000! But the most crucial result of Barbara Bush’s revelation is that palliative care may now be made available to and demanded by the millions who have persevered without it.

Palliative care has been a movement since the 1960’s and it has been a medical specialty since 2006 but until this week many patients languished in the medical netherworld of being treated to death while experiencing unrelieved physical, psychic, and spiritual pain. But a single person - in this case a ‘Great Woman’ – has made palliative care history just by saying aloud “I choose comfort.” She has also changed the course of palliative care history, which is something no other person or organization despite their earnest efforts has been able to do. This is what makes Barbara Bush more than a former First Lady of the United States - it makes her the first First Lady of Palliative Care. 

In deciding to make her remaining life more comfortable, she has also made her approaching death more meaningful. In choosing not to suffer any longer, she has offered the hope of relief from anguish to those patients suffering now. This is a great thing which is why Mrs. Barbara Bush is a ‘Great Woman’. 

 

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Michael A. Salvatore, MD, FACP, CHCQM

Dr. Michael Salvatore was a pulmonary medicine/critical care physician for 35 years. Since 2012 he has been the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. After earning his MD at the University of Arizona, he trained in internal medicine and PULM/CCM at Duke University. Dr. Salvatore is a member of the RACmonitor editorial board.

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