The Cloaking of Death

The term palliative is used freely in the hospice industry and now throughout healthcare. It's root words are the Latin ,palliare, meaning to cloak. Palliate also means to alleviate suffering and symptoms causing suffering without curing the disease. But what is being cloaked? If we return to our story the physician must make it very clear to the patient when Death has taken a stance at the foot of the bed that there is no remedy that can save him and no physician that can heal him. We cannot seem to say these words today. If the heroic pathway is a denial of death then the palliative pathway is the cloaking of death. Kubler-Ross challenged the medical status quo in 1969 with the publication of On Death and Dying. In one brief moment she empowered the dying with a voice and a choice in how they want to die. While our fairy tale physician was turning the bodies of those marked for death around and saving them, Dr. Kubler-Ross was telling the patients there was no more that can be done and now is time to die. We are not good at these conversations. We cloak these conversations in euphemisms and tell the patient we will focus on symptoms now rather than living longer.

What else are we cloaking? Perhaps we are also cloaking the cost of healthcare and palliative care is designed to save healthcare dollars so expensive treatments are not wasted on those who are dying anyway. This healthcare rationing can be cloaked in the Hospice benefit as well as palliative care and it is largely because the rest of the industry has not modulated the addiction to the heroic pathway.

So all this turing of bodies around and betraying Death has had a toll on us but where is this manifested? In our story the physician pays the price with his life. Perhaps the sacrifice in our historical or I should say archetypal drama is the relationship of the physician to the patient, a relationship in which the physician assists the patient in making decisions based on the values of the patient as perceived by the physician. That relationship has died. Now the physician offers choices because he cannot bear the burden of being the betrayer. We are cloaking the betrayer as well as the betrayal.