Sitting in a courthouse for jury duty, it’s strange to be here, recognizing the differences in the work that we do. Here, in the court, there is a judge. There is a jury of the general public that helps to decide who wins the case. There is the presentation of the case, the evidence, the witnesses to provide context for the case brought to the court. But when it comes to our work in palliative care, who is the judge when it comes to making decisions about one’s life and the care we provide? Who are the jurors on a patient’s case? We may deliberate the treatments offered, and the options forward, but how do we prove beyond a reasonable doubt that one option is best, that a treatment won’t work? The thing is, we don’t.

Just as in the court, it is not always black and white. In a civil case, the jury must only tip the scale, in a criminal case there must be proof beyond all reasonable doubt. The same might be said in palliative care. For some patients, we may just need the tip the scale to continue treatment, for others they may only wish to choose an option if cure or death is beyond all reasonable doubt. Unfortunately, illness isn’t like that. We don’t always get to know the outcome. Illness may wax and wane, cures may be unlikely but with ever evolving medical care the next treatment could be said to be just around the corner. There is not always the option to provide recommendations beyond a reasonable doubt. With that, we are often left in a limbo of sorts, wondering what comes next or when the right time is to pivot care. How do you decide to stop treatment if a cure could be possible? How could one ever possibly say no to the chance at life? Yet, we all know too well the suffering that so many endure while hoping for a cure that is just out of reach. We all know and respect the decisions to choose comfort and a quality of life which may not involve seeking the far-off hope of curative or life-prolonging treatments. In palliative care, we act as the jurors, helping our patients to make these decisions: the often heart-wrenching and extremely difficult decisions to make.

So now, I sit here in a spare courtroom, waiting to be pulled in for more questions by the court. I sit in silence, with nothing but the sound of subtle movements of those around me and the far-off sound of sirens outside. How strange it must be to sit in silence when facing a terminal disease, awaiting a sentence that is in fact your life. Sometimes it’s up to the doctors, and sometimes you have no choice at all. Sometimes, all you can do is wait, listen to the facts, and make a choice with the evidence you are given. As providers, we strive to make a choice that is fair and impartial, given the disease, the prognosis, and the context provided by our colleagues all within our patients’ wishes. We take the evidence, we hear the case, we agree to serve our patients and families without bias, with only the facts we have. We listen. We deliberate. Our patients practice their freedom of speech, and we all root our practice in the principles of justice. Then we too must sit in silence, accepting the recommendations we have made with the information and therapies we have available. Supporting our patients through the path they have chosen, hoping in the end one’s treatment was fair and just. The difference? We infuse this justice with love. We provide deliberation with care and compassion, with empathy and a fierce commitment to serve our patients’ best interests first and foremost. It is us against disease, us fighting for life. And when life is not an option, we fight for quality in our patients' days, and peace at the end of life.