Palliative Care - - Why not provide control to a patient?

As the adage goes –“nothing is certain except death and taxes”.    While taxes do seem to beyond an individual’s ability to control beyond casting one’s vote for the latest candidate professing to lower them, death has been something that many fear because of the uncertainty and inability to control one’s final hour.     Even many physicians that routinely have to care for patients with terminal diseases are not always comfortable with discussing death with their patients.    The book Final Exam by Pauline Chen explored this topic and cited many examples of physicians that held out hope to patients even though their condition was terminal.    The topic of Palliative Care has received a lot of attention recently due to the healthcare reform act.    Opponents of healthcare reform protested that palliative care was a mechanism to save costs at the expense of hastening the death of patients.    This outcry was surprising to me since I don’t recall hearing similar attacks against hospice care that has been in existence for some time.    So what is palliative care and what are some of the components of this?    My understanding is that the goal of palliative care is to give patients with terminal illnesses some control over the quality of life that they will experience in their final days.    It includes giving the patient control of the level of pain management and medication that they desire.    This type of care also involves better coordination of care by the patient’s medical team (something that is sorely needed by all patients).    Not only would this include the physicians and nurses caring for the patient, but also behavioral health providers and possibly spiritual supporters that can help both the patient and the patient’s family deal with the inevitable.     Palliative care should only be offered to patients where the evidence is clear that cure is no longer possible.    Many cancer patients are routinely given very expensive chemotherapy drugs in the final stages of their disease that have no verified data supporting curative value.     There was a study cited in the New England Journal of Medicine (August 19, 2010) done by Dr Jennifer Temel and others that found that patients with terminal lung cancer that received palliative care actually had less aggressive care and lived LONGER than the patients in the study that received traditional care.   Granted, this was one study, but it seems to refute those that oppose palliative care as a way to cut costs at the expense of patient’s lives.    If you were faced with a terminal illness, would you opt for palliative care?