Dr James Cooper wrote a comparison of Hospice and Palliative Care, providing some good examples of the emphasis in both hospice and palliative care to encourage the dying person to choose the treatment they want.  He closes his summary by comparing hospice and palliative care  to North America and Europe –

“The basic primer is like a map.  “There is North America, and there is Europe.”  They are separated by an ocean, yet they have much in common. North America is like hospice, with clear boundaries.  Palliative care may be more like Europe, which merges into Asia (which may be like “usual care”).  Where one stops and the other begins is mostly a political decision, just like the separation of palliative vs. usual care.

End of life care can be challenging, and the options may seem murky.  In order to find their way, patients, family members and physicians might benefit from “GPS” systems, including helpful road side assistance to help them navigate these complex health care decisions. Definitions and primers are just the start of customizing this final journey.”  Retrieved Sept 08 2012 

I like the image of needing roadside assistance to help patients and family and the health care team to determine the next steps.

I am struck by the image of “exits”.  There are times when people have the opportunity to “take an exit”.  I fear that we block the exits too often, and people have to journey many many more miles before the ‘next exit’ presents itself.  My heart goes out to those who have to wait longer than they would have in a pretechnology, preantibiotic age.

Kath