Expert on pediatric palliative care speaks at WCM-Q Grand Rounds

An expert in the field of pediatric palliative care spoke at the most recent instalment of Weill Cornell Medicine-Qatar’s (WCM-Q) Grand Rounds.

Dr. Amrita Sarpal, senior pediatric critical care physician at Sidra Medicine and assistant professor at WCM-Q, gave a lecture titled Pediatric Palliative Care: Unraveling Common Myths, Misconceptions and Misunderstandings. Dr. Sarpal, a Fellow of the Royal College of Physicians and Surgeons of Canada, gave a definition of pediatric palliative care, before explaining how to differentiate resuscitation status from the goals of care, and giving an overview of the ethical principles that guide symptom management towards the end of life.

Speaking to an audience of physicians, nurses, dentists, pharmacists, allied health professionals, students, researchers and educators, Dr. Sarpal said: “It is important to break down some of the myths and uncertainties that surround palliative care. Firstly, palliative care does not hasten death, as some believe. In fact, studies have shown that early palliative care leads to less aggressive care at the end of life and longer survival. Palliative care is actually about providing comfort and the very best quality of life possible for patients and their families who are facing a life-threatening illness.”

Dr. Sarpal also said that palliative care is not the same as hospice care. Rather, palliative care begins at the time of diagnosis and is delivered alongside curative treatment for patients with life-threatening illness in order to maximize comfort and quality of life. According to the definition of the World Health Organization, this is achieved, “through the prevention and relief of suffering by early identification, impeccable assessment, and the treatment of pain and other problems, physical, psychological, and spiritual.” In contrast, hospice care begins after disease-related treatment has ended when it is clear the patient will not survive the illness.

Dr. Sarpal added that it is often believed that palliative care is only for people with cancer, which is not the case. In fact, the majority of children who receive palliative care do not have cancer. Furthermore, research has shown that children’s palliative care is considered an appropriate course of action for almost 400 conditions, she said. Dr Sarpal also explained that palliative care does not mean ‘giving up’ and that curative treatments remain open while palliative care is being delivered. However, when it is acknowledged that a cure is not possible, the focus of palliative care can be altered to emphasize living life as fully as possible in accordance with the wishes of the patient and their family. Other myths that must be dispelled, she said, are the idea that morphine is used to hasten death, when in fact it is used only to alleviate pain, and that pain medication necessarily leads to addiction, which is not the case.

In relation to the ethical principles guiding the provision of palliative care, Dr. Sarpal said these fall into four categories: justice, autonomy, beneficence, and non-maleficence. Pain medication must be administered extremely carefully to relieve pain as far as possible without unwittingly hastening death, which is a risk as some medications can impact breathing and blood pressure. Overall, those providing palliative care must attempt to uphold the Hippocratic Oath while simultaneously respecting the wishes and values of the family, she explained.

The lecture was accredited locally by the Ministry of Public Health’s Department of Healthcare Professions – Accreditation Section and internationally by the Accreditation Council for Continuing Medical Education (ACCME).