Palliative Care: Applying “The Platinum Rule” for My Patients

Palliative Care: Applying “The Platinum Rule” for My Patients

As a palliative medicine consultant, I see patients and families during some of the most arduous days of their lives. Perhaps it’s the elderly Navy veteran with newly diagnosed end-stage cancer with uncontrolled pain, weakness and loss of appetite who is conflicted about pursuing treatment. Or the devoted matriarch of seven children and ten grandchildren with septic shock who is on a ventilator and clinically deteriorating but whose family believes she would want to be kept alive with any medical interventions possible. These are complicated interactions—not only from a medical standpoint but from an emotional one.

Keeping Patients Informed

It is my job to educate patients and families about the realities of the illness and the likely outcomes of medical interventions. The prevailing wisdom is that to practice patient-centered care, we must treat others as we would want to be treated—sometimes referred to as “The Golden Rule.” However, a palliative mentor of mine recently shared commentary from The Journal of Palliative Medicine that shifted my perspective. The author, Dr. Harvey Max Chochinov, suggests that “The Platinum Rule” may be a more suitable standard for achieving optimal patient-centered care. Rather than treating others as we would want to be treated, The Platinum Rule acknowledges that every person has a different set of values and beliefs and emphasizes treating others as they would like to be treated.

According to Dr. Chochinov, when we practice from the vantage point of beneficence (doing good to others), we tend to perceive a patient’s suffering based on how we would imagine suffering. This perspective may lead to well-intentioned actions or advice being at odds with what the patient or family desires.  Reflecting on this idea led me to humbly explore my own unconscious bias.

Cultural Humility

Recently, I met with the family of a young, West-African woman who was hospitalized with multiple, complicated auto-immune conditions, aggressive wounds and a hospital-acquired COVID-19 infection. She was actively dying, and the medical team was conflicted about the futility of CPR, while the family wanted to pursue any interventions that would prolong her life.  

Both the medical team and I presumptuously assumed the patient’s family did not understand the futility of aggressive medical interventions. In actuality, we failed to understand their perspective because we unconsciously assumed the patient’s and family’s values and concerns aligned with our own. But the family did understand the patient’s grim medical reality. It was the team (including myself) who lacked the cultural humility to understand an alternative view of the decisions they were being asked to make.

Ultimately, Dr. Chochinov’s perspective on The Platinum Rule has changed the way I assess effectiveness in my own practice, as I hope it will for others. I no longer seek to influence behaviors but, rather, to intimately understand the values and beliefs of others, especially when they are different from my own. In a culture of medicine focused on patient-centered care, to truly understand how to best treat others, we must first appreciate how they would treat themselves.

This blog was written and contributed by Mary Onderdonk DNP, CRNP, Gilchrist Integrative & Palliative Medicine Nurse Practitioner

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