Does It Matter Whether a Psychiatric Intervention Is “Palliative”?

Abstract

Palliative interventions are intended to alleviate suffering and improve quality, not quantity, of life and are not intended to cure illness. In psychiatry, uncertainty about which interventions count as palliative stems from the fact that psychiatry generally prioritizes symptom management irrespective of diagnosis or specific pathophysiology of illness. This commentary on a case considers how distinctions between palliative and other psychiatric interventions might not be all that helpful in resolving clinical and ethical questions about which interventions are-and when they are-appropriate. The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case CC is a 40-year-old patient who has experienced multiple shifts in diagnoses over 10 years among mood disorders, substance use disorders, and personality disorders. CC is currently recovering from a 6-year addiction to cocaine and has been involuntarily admitted several times during the last 8 years for self-harm. After just over 1 year of reliable symptom control with an antidepressant, electroconvulsive therapy, and psychotherapy, CC is again experiencing passive suicidal ideation and worsening depression. Dr P worries that CC might attempt suicide or relapse into drug use and wonders whether a new US Food and Drug Administration (FDA)-approved drug for depression and suicidal ideation would help. This drug rapidly reduces suicidal ideation in a matter of hours in some cases, but evidence does not yet reliably indicate how long suicidal ideation is reduced after treatment or whether suicidal ideation reduction is attributable to dissociation and euphoria, for which the drug has become known since it started being used recreationally. CommentaryCases like this one frequently confront psychiatrists and other mental health professionals. They raise important questions about how these practitioners should address severely treatment-refractory symptoms. The case also raises a difficult question about whether an intervention that carries a risk of addiction-since the proposed intervention produces euphoria, which is associated with dependence 1should be used in order to achieve other benefits, such as the reduction of suicidal