The Limits of “Life-Limiting”

The field of hospice and palliative medicine has struggled to define the conditions that are appropriate for palliative care. “Life-threatening” appropriately encompasses lethal conditions and helpfully incorporates the concept of probability, which is a necessary variable in any risk calculation. Yet it leaves one important group of patients unaccounted for: those whose primary need for palliative care is not expected abbreviation of life but rather the quality of that life. In an attempt to include these patients, the term “life-limiting” has come to be used more frequently. Although attractive in its breadth—and at first glance appearing to be a less threatening way to introduce palliative care—the term is inherently flawed. It denotes a certain outcome, without any consideration of the likelihood of that outcome. Rather than “softening the blow” of introducing palliative care, the term seems to condemn a patient to the very outcome that palliative care is tasked to ameliorate, namely, the limitation of life. As such, it may provide a distorted view of what palliative care is, especially in pediatrics where the term is used with disproportionate frequency. The inherent misplaced certainty of “life-limiting” and the self-defeating message it sends to patients should be acknowledged.