"Palliative Care" is a concept of patient care that originated over 50 years ago in England by Cicely Mary Strode Saunders. She recognized that patients with severe illnesses like cancer, who were in incurable stages, were often advised by doctors to return home to live out their remaining days.
However, Cicely Saunders observed that the time patients had left before death was often filled with suffering—physical symptoms like pain and breathlessness, as well as emotional disturbances such as anxiety. Families and those close to the patients witnessed this suffering and had to come to terms with the imminent loss of their loved ones. At that time, there was no concept of palliative care; the focus was solely on curative treatment.
Later, the concept of palliative care spread to many countries, shifting the approach to care. Patients whom doctors once saw as hopeless and near death were now recognized as "still living." Physicians began considering how to provide care that would make patients happy and improve their quality of life during their final days.
Care began with managing troublesome symptoms like pain and breathlessness, and expanded to other dimensions such as psychological support. The goal was to help patients feel that life still belonged to them, enabling them to face their changing health and choose how to spend their remaining time meaningfully.
Additionally, patients should have the right to decide on their own treatment during the end-of-life stage. Some treatments may merely prolong life or lead to bedridden conditions requiring ventilators until death, which might not be what the patient desires.
Conversely, patients might be happier staying at home with family, living as they wish—waking up when they want, eating what they want, doing important things before passing away. They can choose where to spend their final days. In essence, patients become the "designers" of their end-of-life experience, supported by medical teams rather than having doctors make all decisions. Studies show four key things patients wish to do before passing.
Palliative care thus aims to provide patients and families with the best possible time in the remaining life, addressing all aspects until death. Moreover, palliative care teams continue supporting families after the patient's death to help them adjust to their loss. If difficulties arise, psychologists or psychiatrists provide mental health care to prevent depression. At Ramathibodi Hospital, biannual activities invite relatives to merit-making ceremonies in remembrance of the deceased, including art and music therapy sessions, to help families cope and move forward after loss.
The definition of palliative care divides patients into two groups as follows:
If death is to occur at home, patients can ask their attending doctor to provide documentation of their illness, which helps facilitate post-mortem procedures.
For healthy individuals, it is advisable to plan ahead for care preferences by expressing their wishes regarding treatment. Often, treatments cause suffering without cure but only prolong life. Advance care planning forms can be completed at clinics specializing in this, sometimes called 'Lighthearted Clinics'.
These advance care planning forms allow individuals to communicate their preferences to medical and nursing teams, specifying what they want or do not want if they become seriously ill and terminal. This reduces the burden on family members and ensures the patient receives care aligned with their wishes.
Information provided by Associate Professor Dr. Kitipol Nakviroj, Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University.