Remembering Dr. Kubler-Ross as a pioneer in modern palliative care

Regarding "On Death and Dying author dies" (AMNews, Sept. 13)

With the death of Elisabeth Kubler-Ross, MD, it is fitting to review her seminal contributions to a culture shift in medicine.

At the turn of the last century, the revolution in medical education, led by Abraham Flexner and Dr. William Osler, placed it firmly on a foundation of rational science. They posited research as the medical faculty's primary responsibility. Clinical teaching was demoted to a lesser role.

The unintended consequence of this shift became a compartmentalized and depersonalized system of medical education. As technology grew exponentially, the physician-patient relationship suffered further.

Initially, most people chose medicine out of a desire to relieve pain and suffering, viewing technology as a means to that end.

If medicine is to return to its threefold role as 1) the most humane of the sciences, 2) the most scientific of the humanities, and 3) the most empiric of the arts, then the place of meaning that resides within the physician-patient relationship must be recreated and expanded.

Her quest both as person and physician was to embrace and attend to the suffering of the "other." She catalyzed the hospice movement from which the more inclusive palliative care model grew.

Palliative care, an extension of the rehabilitation model, addresses the entire spectrum of pain and suffering throughout an illness, including dying and death. It acknowledges and addresses the suffering of all: patient, family, community and caregivers, including physicians. These experiences are emblematic of medicine's humanity and the primacy of its human meaning over technology and science.

While high-tech care remains medicine's dominant interest, palliative care ought to be medicine's first priority. Only then can the profound model of compassion that was the legacy of Dr. Elisabeth Kubler-Ross become a living memorial in what remains the bedrock of medicine: continuity of relationship, unconditional love and respect for each and every patient.

Joseph F. Fennelly, MD, Madison, N.J.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/10/04/edlt1004.htm.