Dr. Michael J. Taylor

With the rapid progress in medical knowledge and technology over the past several decades, caring for patients with terminal illness has become increasingly challenging to both individual physicians and to the profession of medicine as a whole. In addition to keeping abreast of an ever-growing body of palliative care literature, physicians caring for terminally ill patients must often make management decisions that are difficult because outcomes, such as the impact on quality of life and the potential to increase patient survival, are hard to predict. The resulting uncertainty combined with the fear and anxiety experienced by physicians, patients and families facing terminal disease, often presents obstacles to effective communication among all parties. Furthermore, in busy inpatient and outpatient settings, the palliative needs of terminally ill patients may be overlooked by physicians who are trained to focus on the prevention and cure of disease, but are ill-equipped to meet the challenges of attending to a patient's spiritual and psychosocial 'end-of-life' needs. The following article examines some of the current deficiencies characterising the care of the terminally ill, and highlights a number of the obstacles to overcoming these deficiencies through a brief survey of some of the literature that addresses this complex issue.