There are common themes within palliation practice that have relevance to many of the diseases under consideration and the common discomforts that are experienced:

1. Holism: considering multiple interactions and influences.

2. Recording observations of distress: analogue scales.

3. Involving the team: communicating, recording and supporting.

4. No correct answer: innovation and experiment.

5. Appropriate therapy regimens.

6. Support of carers.

7. Working with complementary and alternative medicine.

HOLISM

Holism was a term coined by the South African philosopher and statesman Jan Christian Smuts. It signifies that an entity is more than the sum of its parts, that it will not be fully understood by analysis, but will also need an appreciation of its operation as a whole, and the many relationships that bear upon it.

The term has been well received by practitioners of palliation, who recognize that disability, discomfort and dependency (common outcomes of neurological disease) create a complex pattern of distress that is not satisfactorily described as a list of symptoms, but needs also an awareness of the way daily life of the affected individual has been changed in its physical, emotional and spiritual components. Spiritual and emotional needs are just as real as physical ones, and may need to be approached by persons drawn from outside the conventional medical scene.