Palliative Psychiatry, MAID, and Moral Disagreement with Dr. Daniel Buchman

Our envisioning of palliative psychiatry is that people are not at the end of life a-at all, and I think actually if you look at the WHO definition of palliative care, there is nothing in that definition about end of life.

And it's-- Although you're absolutely right that I think in the cultural imagination, palliative is synonymous with end-of-life care, and it's the idea that if it's synonymous with end-of-life care and there's a lot of stigma associated with that, that means you're giving up, you're, you're not-- there's nothing more we can do, you're giving up hope.

And if you talk to any palliative care professional, they say that is the exact opposite of what we do [chuckles] in palliative care, in physical medicine.

Um, and I would say the same thing as we're, you know, conceiving this idea of what a potential palliative psychiatry could look like, is that it's not about people who are at the end of life.

I think people may be at risk of dying because of their mental illness, or they might be because of, for some people, maybe conditions related to the social determinants their, of health, which makes them at increa- that increased risk, but that's-- but they're not at end of life.

And, you know, palliative care advocates and others have gone to great pains to say like, "Hey," like, "let's talk about early integration of palliative care." We know from the evidence that we introduce palliative care early in the, in the disease process, not only is it enhanced quality of life, but actually quantity of life.

[chuckles] Um, people do live longer.

So I think there's a lot to also learn from, from there, um, and that it's very-- it's, it's not an all or nothing.

It's not that we can't continue to provide other sort of treatments alongside potentially more palliative interventions at all.

Um, I think-- But I think when people hear the word palliative, they get very nervous and, uh, I understand why, and I think there's a lot of misconceptions out there, and not just amongst, um, you know, various lay publics, um, people who might not be in healthcare, but a lot, a lot, amongst a lot of healthcare professionals, and there's a lot of evidence to suggest that a lot of healthcare professionals also equate palliative care with end-of-life care.

And it's, it's, um, you know, palliative care I think often is in practice provided alongside end-of-life care for a lot of people, and maybe that's where they see it, and they don't always see the early intervention or they don't always understand it as a philosophy of care as well.

So that could be part of it where there's that sort of intense stigma even amongst healthcare professionals.

But I think we're also, you know, in a death-denying society in many ways.

And so I think there's-- we still have a lot of that stigma associated with the term palliative, and so that's gonna, you know, come up I think in when we talk about this.

In, in the research project that I'm involved with right now in palliative psychiatry, we have an advisory board, um, made up of healthcare professionals and people with lived experience of severe and persistent mental illness and others, and we've had a lot of like really great discussions about this term palliative and-- or this term palliative psychiatry, and it's like, should we call it something else? And people are split.

Um, you know, folks are saying, "Well, no," like, "we-- let's not call it that because of the reasons that you just mentioned, because of the stigma associated with the term palliative, the association with end of life, and that's not what we're talking about." And other people say, "Hold on.

No, no, we need to call it that and normalize the term and help support people understand what it actually means.

And so we should not abandon the term, uh, in the interests of this sort of existing stigma." So a-anyway, it's-- uh, that is also made from ve-very spirited and, and fruitful discussions with the, with the, uh, amazing advisory group that we work with.

From, from your intonation, I'm guessing that you're-- you mo- you more ascribe to the latter, which is that we should stick with palliative and try to change people's perceptions of it?

Yeah, I think, I think there needs to be-- Yeah, I mean, I, I guess I'm-- I do lean, maybe lean towards that perspective.

Um, but I'm very open to considering other terms if they might be more helpful, um, right? Again, listening to perspectives of people who are-- who might be directly affected by a palliative approach, like, you know, what do they think about it and what might they want to call it? And so we're, we're actually doing that research right now.

Uh, I have nothing sort of to report preliminary findings, uh, yet, but, um, to be-- to, to, to, to be determined.

But, um- We want to know that.

Like, and so part of me is like, yeah, we should absolutely, you know, do some really good important public engagement or engagement work with healthcare professionals, families, people who've experienced, others, you know, just around, around these terms because I think, um... because people, people get their-- people have a, have a tough time with it.

Mm-hmm.