| Show Matter Mattero of o young g life and I Ii i death r r i Susan Brink Los Angeles Times When a patient is a achild achild achild child or a young adult the i decision to stop aggressive treatment involves the same equation that older people consider Patients and their 1 I families weigh the p pain in 1 s sand and suffering of treatment i I against the likelihood of or success But when there are potentially decades i of life ahead the answer is likely to tilt urgently toward continuing treatment even JOt if it i is only remotely promising For younger people the hospice rule requiring a prognosis of six months or orless orless orless less to live can be too cruel a dose of The choice for patients patents has long been stark give up aggressive treatment for comfort care or continue medical interventions and risk sacrificing sacrificing quality quality of life Last September the California Legislature I moved toward mal making ing it a little easier for the to California I I families facing heart- heart I wrenching options for their youngsters The Nick Snow Childrens Children's Hospice and Palliative Care Act of 2006 named for a child hild with a aLife aLife aLife Life and death Continued on page 3 I Young life and death Continued from page 1 brain tumor who flunked hospice care twice when his condition temporarily improved will let seriously ill children receive hospice and palliative care without having to forgo medical treatment that might cure them or prolong their lives The act is expected to be implemented next year Palliative care a relatively new field of medicine can help bridge the or either gap Its It's a lot like hospice but can step into a patients patient's life sooner before the last six months of life or before someone is ready to give up upon upon upon on on medicine Specialists in palliative care emphasize pain and symptom management coordinating family individual and spiritual counseling understanding the patients patient's treatment goals and ensuring that the whole J I medical team understands the patients patient's and family's wishes Meanwhile medical treatment continues Treatment might buy precious time For children that might mean experiencing a first prom camping trip or part in a play Refraining from treatment on the other hand might buy a child enough comfort free of side effects to live a amore amore amore more normal life Weve had children who were expected to die and they lived an extra year and a half says Dr Lonnie director of the pediatric pain p program a at Mattel MatteI Childrens Children's Hospital at the University of California Los Angeles What we do may involve not either orf Its It's different different from the past con concept ept of hospice which was seen as give up upi medicine What parent wants to give up on ona ona ona a child Most parents and children old enough to be involved in treatment decisions J d want to go all the way with medicine says Elana Evan a psychologist and coordinator of the pediatric palliative care program at Mattel MatteI They need frank discussion about what the chances are and the likely outcome Palliative care provides a communication bridge between the family members who know the child best and the specialists treating the child What food do they like what toys do they need with them at atall atall atall all times Do they want medical details or prefer not to know Its such a afine afine afine fine balance Evan says Its offering hope while still presenting the larger picture Some older children make a decision similar to Art Buchwald's telling their parents that they can cango cango cango go no further recalls a teenage patient in Los Angeles who went through three heart transplants Her body rejected them all Her parents wanted her to try again but when she insist insisted d she wanted no more they agreed in consultation with the palliative care team that it was her choice |
