Two decades of palliative care.

Western anthropology, based on the belief of dualism of body and mind, has unconsciously but profoundly influenced the basic approach to medicine for centuries. This separation of body and mind has become greater since the day of Decartes. Medical care has thus focused more on disease than illness, pain rather than suffering. New medical technologies bring new hopes of cure, but fail to alleviate the distresses of patients with incurable disease, as expected by patients. Illich and Clark vividly described the scenario of death and dying during the 1970s as “medicalisation of the dying”. Every effort is made to combat death, rather than to come to terms with dying. Dying is often perceived as medical failure. The SUPPORT study published in 1995 revealed that half of the 9105 terminally ill patients spent at least 8 days in coma, in intensive care, or in pain before they died. Many patients’ needs were unmet. Moreover, when considering disease burden, end-of-life care should be seen as a global public health issue. If we estimate that each death affects four persons who are closely related to the dying person, with an annual death incidence of 30 000 in Hong Kong, 2.5% of our population will be affected by issues of end-of-life each year. Can doctors rise to the challenges of care for the dying?