Social work is needed when people with long-term illness are helped to live their lives rather than treated aggressively

Renal medicine often presents problems for palliative care because people with serious or end-stage renal problems are often on a treadmill of regular and frequent dialysis and sometimes waiting for a transplant. Because of this it can be very hard for their medical teams to identify when they have reached the point when they should be seen as dying, and their service should take on a more palliative tinge. They often are – and feel – very ill a lot of the time, but may not experience the fear or ‘death sentence’ that people associate with cancer. At least, people used to associate the death sentence with cancer. Increasingly, though, people with cancer are treated successfully, go into remission and survive for many years and so the same issue sometimes applies: when do I decide that enough is enough (and how do I get my doctors to accept this)?

An interesting article compares survival of people with end stage renal failure who go on receiving dialysis, and those who are treated conservatively, with symptoms being managed and advice about managing their lives. At age 70, those on dialysis live longer, but may spend more time in hospital. At 80, they do not survive longer. And in both cases, those not using the hi-tech dialysis often lead very satisfactory lives.

This study speaks to a lot of things. First, they included a social worker in the team to support the conservatively treated patients. this is sensible: if healthcare services are going to focus on living a good life successfully, then people’s social relationships and arrangements for their lives are going to become more important.

Second, it raises some questions about assisted dying. Perhaps we should be looking at assisted living for people at the end stage of major illnesses, rather than arguing that they might be helped to die, or treating them aggressively and then despairing when this does not provide a very god lifestyle. Conservative treatments for major illnesses are not assisted dying, but they are providing the kind of assisted living that people feel is valuable.

Third, there is often far more choice about how you are treated if you have a major illness than the stark choice of suffering aggressive treatment or dying.

Link to the article.