The International Congress on Palliative Care will be held this year in October 2022 and there are many changes afoot, namely a new co-chair of the Congress: Dr. Justin Sanders. Together with the esteemed Dr. Bernard Lapointe, who has been chairing the congress since 2014, Dr. Sanders will bring his distinctive frame to the congress while building a new vision and mission in his new position as the Kappy and Eric M. Flanders Chair in Palliative Medicine. (Full disclosure: I am on the congress executive and my name is Flanders -- hence I am connected to the Flanders Chair in Palliative Medicine -- and proud of it!)
Dr. Sanders stands on the shoulders of giants: Dr. Lapointe who has just recently stepped down, and Dr. Balfour Mount before him. Dr. Sanders, or Justin as I know him, has recently arrived in Montreal from Boston. He’s fully engaged, has lots of energy and ideas and is ready to take palliative care to the next level.
While COVID has struck all of us, it has hit the medical community excessively hard. All our placards thanking our healthcare workers pay homage to the endless hours they have spent trying to help us all find our way out of this pandemic. They risk their lives every day and the cracks in the system could not be more manifest than they are now. ICU bed shortages are not the doing of the pandemic, they are merely exposed because of the pandemic. Not having an extensive enough palliative care system in place has left people dying in terrible circumstances. And just for clarity, only 15% of Canadians received publicly funded palliative home care in their last year of life.
Dr. Sanders calls the fallout from COVID a crisis point in the healthcare system, and this will be one of the main focal points of the congress. But his path to address this will be through a conversation on healing.
I interviewed Dr. Sanders recently and asked him to give us a little intel about his thinking for the next international congress on palliative care.
EF: Tell me a little about yourself
Well, first and foremost, I’m an optimist and that optimism pervades every aspect of my life and work. But that’s a tough question to answer: Who are you? I’m a physician, a father and an academic. And one of the things I’ve realized over the last few years, and why I struggle to answer who I am/who we are all are, is because it pales in comparison to what we do. We spend our formative years trying to become something because that gives us a point of focus, but I’ve been influenced in the last few years by what we do rather than who we are.
EF: You’ve just become co-chair with Dr. Bernard Lapointe of the McGill International Congress on Palliative Care. Tell me a little about your vision for the conference:
First, I owe a debt of gratitude to Bernard for sticking around as co-chair of this meeting. He has put so much into the planning and I have so much to learn from him as to how to chair this for the future.
My vision for this congress is an opportunity for healing. It goes without saying that the congress will be happening at two and half years into a global pandemic in which health care providers have suffered immensely as a result of the day-to-day caring for people with COVID, and the day-to-day of caring for those with serious illness whose treatments have been put off by COVID. Our field is in a crisis, not just palliative care, but medicine is a crisis. I envision the congress therefore as a time of connection and healing from this very difficult time. I think back to the early days of the pandemic as a clinician and in my few weeks of working embedded in the intensive care units at Brigham and Women’s Hospital, it was hands down the hardest week of my decade-long career. And I know that’s true for so many who have worked so many more hours and weeks than I have.
So that’s my hope- that this congress will be a place of healing, of coming together and finding a new way forward.
EF: Can you elaborate on the crisis you think we are in?
The immediate parallel to the crisis we face is one that is experienced by all people who have a serious illness in that there is uncertainty, loss and grief. We have experienced all of those things in the last two years of our professional lives different in scale and intensity to the day-to-day loss and grief that we sit with as part of our work as palliative care clinicians. It has been made more difficult by the separation imposed by this virus; you know, standing at the bedside of a dying person, holding an iPad while their family weeps tears to say goodbye is a small trauma. I think (as clinicians) we have experienced many of those and have done so in the face of political indifference at times, and it’s felt like a betrayal – a betrayal of the public trust; we are part of that and have suffered as a result of that — healthcare broadly, and palliative care clinicians in their role in providing expertise in the end-of-life care. We have to move on to some degree, but to do so we have to make meaning of this experience. “Meaning-making” is a relational process. Dame Cicely Saunders said that “you matter, and you matter until the end of your life,” and mattering is a relational process, you matter to someone and they to you.
And so, we need to discover these points of connection at the congress that help us heal by understanding that we matter to each other, that we matter to the world, that we matter to our loved ones and our work matters.
EF: Where would you like to see PC go in the next 10 years?
I’d like to see palliative care reconnect with the way it started; the ideas and insights that were at the beginning of this work. But like many bodies of knowledge in the Western world and in medicine, I think we have a lot to learn from people, from underserved and marginalized communities – that is those communities that we have underserved: black and brown people, people from diverse cultural backgrounds. Palliative care is no different from the halls of white men that line the walls of our medical schools. We need to ensure that the voices that inform our work are not just white forefathers and foremothers, because they represent a relatively small perspective in a global scale. It’s a tension because you want to honour and recognize the insights that are at the foundation of this field, but ours is a white body of knowledge and while there is something inherently culturally sensitive and humble about the idea that we are focused on starting with things that matter most to people, and trying to provide and ensure healthcare that reflects those things, we still have a lot to learn about what it means for different people to confront this time of their lives. We need to think about how we structure our field to gain insights from different communities. That’s what I’d like to see for the future of palliative care and medicine more broadly.
EF: If you had one thing you could improve regarding the field of Palliative Care, what would it be?
Throughout my own career in palliative care, I’ve come to a point figuring out just how critical relationships are to our work, the degree to which we promote authentic healing relationships in our practice is one of the most critical things that we do and in part because of the ripples that those relationships have in the lives of patients and people affected by serious illness.
It’s interesting going back and reading some of the early writings in our field by Balfour Mount and Cicely Saunders and realizing that some of the greatest early insights that have fallen to the side have done so in part because of a natural progression of the field to gain legitimacy in a larger medical enterprise. In our attempts to create more “hard science” around what we do to gain reasonable and increasing sophistication around symptom management, we have given up some of the interdisciplinarity. But the very early writings talk about our attention to these relationships and multiple dimensions of suffering that people experience that gave this field its birth. I think that when you look at how palliative care is practiced, some of these relationships are exactly what we need in the future, not just for palliative care but for medicine more generally.
We owe our patients the greatest sophistication possible when it comes to taking care of their symptoms, but that’s not the end point, the work that we do to alleviate physical symptoms is in service of something greater. Yet much of the way we structure health care and palliative care in hospitals is that alleviating pain is the end point rather than an opportunity to open a door to something more important – the opportunity to experience the move towards integrity and wholeness that comprises healing. At the foundation of this field is the idea that healing is possible throughout the course of serious illness and even up until death. And that is very counterculture in medicine, which acts as if death is the enemy that we should fight it at all costs. There is nothing particularly wrong with that idea because we want to live and to celebrate and to honour this opportunity of living. However, we all die, and we minimize the importance of the inevitable time when we become sick and approach the end of our life.
Healing is possible through the course of serious illness and at the end of life. This idea is simultaneously ancient, subversive, and foundational in our field — I think that’s a very important thing.