Clinical and Ethical Issues in Palliative Care

Over the past 15 years, in response to widely-recognized gaps in the care of patients at the end of life, palliative care has emerged as a recognized subspecialty, focused on the care of patients with advanced, progressive, life-threatening illness. The aim of palliative care is to optimize the quality of life for the patient and family through the provision of expert interdisciplinary care, including symptom assessment and treatment, psychosocial and spiritual support to the patient and family, help with complex decisions about treatment options, coordination of care in the community, and bereavement care for families. A growing evidence base demonstrates the effectiveness of palliative care clinical programs in improving symptoms, quality of life, communication, concordance between patient wishes and care received, family satisfaction, and bereavement outcomes and in reducing costs. There are many opportunities for psychiatrists to contribute to care for patients at the end of life through enhanced involvement in palliative care teams.