To the editor:

The modern American approach to the treatment of life-threatening illness appears to center upon the principles of fighting aggressively and maintaining hope (“Americans are treated, and overtreated to death,” Journal-World, June 28). Much has been made of the vast expense and frequent futility surrounding end-of-life care. However, economic considerations are but one small part of the planning of this care.

Decisions regarding care of serious illness should ultimately be made by patients and their families, with health care providers offering assistance. Hope must never be abandoned, but often must be reframed. If one chooses the most aggressive form of medical care, hoping for the best outcome, then that desire should be honored. But if an illness will likely end in death, then one might choose to emphasize the quality of the remaining life. Hope, then, may become living comfortably in the presence of loved ones, focusing on repairing damaged relationships, making sure that the survivors are cared for and engaging spiritual issues.

Often the discussion of the care of advanced diseases centers on medical risks and benefits. The most aggressive care often results when both patient and physician believe that it is what the other party desires or recommends. The central question should perhaps be “What will the remainder of my life be like if I choose this type of care?”

In our community there are well-trained professionals who are educated, experienced and certified in both the medically aggressive and holistic comfort care of life-threatening illness.

Dr. Richard Sosinski,

Lawrence