Dr June Michael Razon on the misconceptions about hospice and palliative medicine

Hospice and palliative medicine is often less understood even among doctors. Is it only for the dying? Is it covered by PhilHealth? Dr June Michael Razon,* MD, MMHA, FPAFP, FPSHPM, Section Head of Supportive, Hospice and Palliative Medicine, East Avenue Medical Center, recently discussed with MIMS Doctor his insights on hospice and palliative medicine.

What drew you to hospice care and palliative medicine?

As a family physician, I’ve always taken care of patients across different stages of life, and I realized that many patients with serious illnesses were suffering from symptoms and challenges that weren’t being fully addressed. I also saw how difficult it was for families to navigate these situations, often with very little support.

That experience made me recognize the huge gap in palliative care in the Philippines. There’s still a significant unmet need, especially in symptom management, advance care planning, and end-of-life support. I felt that hospice and palliative medicine was where I could make the greatest difference—not just by treating illness, but by improving the quality of life for both patients and their families across the various stages of the illness trajectory. 

“ONE OF THE BIGGEST MISCONCEPTIONS IS THAT PALLIATIVE CARE IS ONLY FOR PATIENTS WHO ARE ABOUT TO DIE.”

What are the most common misconceptions about hospice care and palliative medicine among Filipino families?

One of the biggest misconceptions is that palliative care is only for patients who are about to die. Many people are surprised to learn that palliative care can be introduced much earlier in the course of a serious illness, even while patients are still receiving treatments such as chemotherapy or other disease-directed therapies.

Many people, including some doctors, interchange palliative and hospice care. Hospice care is a specific type of palliative care rendered to a patient with limited life expectancy focusing on relief of symptoms than disease-modifying interventions.

A lot of families also think that being referred to hospice means giving up on their loved one. In reality, hospice is not about giving up—it’s about shifting the focus from curing the disease to maximizing comfort, dignity, and quality of life. The goal is to help patients live as fully and comfortably as possible.

How does our family-oriented culture affect end-of-life decision-making, and how do you navigate family dynamics when it conflicts with a patient’s advanced directives?

Filipino culture highly values family responsibility, sacrifice, and caring for loved ones. Because of this, some families feel that stopping aggressive treatment means they are not doing enough. They may also avoid discussing death or prognosis because they want to protect the patient from emotional distress.

Handling difficult conversations, goal-setting, disclosure, and advance care planning are among the services a palliative care specialist can provide. We apply various psychosocial counseling skills to navigate through these difficult conversations while addressing other forms of suffering altogether. 

Local experts often decry the stigma and limited access to painkilling opioids in the country. How does this affect your ability to manage severe pain for patients?

In areas where opioids are limited, I focus on a thorough pain assessment, optimize non-opioid and adjuvant medications, and incorporate non-pharmacologic interventions. However, I also recognize that many patients will require opioids for adequate pain control. In those situations, part of my role is to advocate for improved access to essential pain medications and help build systems that ensure patients do not suffer unnecessarily because of where they live. Effective cancer pain management requires both good clinical care and health system advocacy.

Many families and patients worry that morphine causes addiction or that it will speed up death. These fears are understandable. In palliative care, we allow them to ventilate their thoughts, fears and anxieties, and correct emotionally critical misperceptions. We reinforce that when used appropriately by trained healthcare professionals. Morphine is one of the most effective and safest medications for relieving severe pain and breathlessness. Its purpose is to reduce suffering, not to hasten death. 

Treating “total pain”—physical, emotional, social, and spiritual—can you share how you and your team build care plans?

One of the things I love about palliative care is that we don’t see pain as purely physical. Medications are important, especially when symptoms are significant, but they’re only one part of the solution. We try to understand what is contributing to a patient’s suffering as a whole.

For example, if a patient has uncontrolled pain, we also explore whether there are emotional factors such as anxiety or depression, social concerns like financial difficulties or caregiver stress, or spiritual questions about meaning, faith, or fears about the future. Sometimes addressing these issues can significantly lessen a person’s suffering even when the physical illness remains.

That’s why interdisciplinary teamwork is so important. Physicians, nurses, social workers, psychologists, other specialists, chaplains, and other team members each bring a different perspective. Together, we create an individualized care plan that may include symptom management, counseling, family meeting, caregiver support, advance care planning, and spiritual care—not just medications.

At the end of the day, our goal is not simply to reduce a pain score but to help patients live as comfortably and meaningfully as possible despite serious illness.

How is the shift toward home health and community–based hospice care changing patient experience?

In a busy area like NCR, many hospitals are often crowded, and patients with serious illnesses can end up spending a lot of time traveling to appointments or waiting in clinics. The shift toward home health and community–based hospice care is helping change that experience.

Instead of requiring patients to stay in the hospital, we can bring much of the care to them in the comfort of their own homes. Patients are able to spend more time with family, maintain their routines, and stay in a familiar environment, which can greatly improve their quality of life.

Home-based care also allows us to better understand the patient’s day-to-day challenges and provide more personalized support. For many patients and families, it reduces stress, minimizes unnecessary hospital visits, and gives them a greater sense of control over their care.

While there are still challenges in expanding these services, I believe community-based palliative and hospice care is an important step toward making healthcare more patient-centered and compassionate.

Has telemedicine become an effective tool for you to monitor patients and guide family caregivers in their homes?

Yes, definitely. Telemedicine has become a very useful tool for palliative care, especially for patients who have difficulty traveling or are more comfortable staying at home. It allows us to check symptoms, review medications, and identify concerns early without requiring patients to come to the hospital. It’s also been very helpful for supporting family caregivers. Many times, caregivers have questions about pain management, new symptoms, or what changes to expect. Through teleconsultations, we can provide guidance, reassurance, and education in real time.

Of course, telemedicine doesn’t completely replace face-to-face visits. There are situations where a physical examination or home visit is still necessary. But as part of a comprehensive care plan, it has improved access to care, strengthened communication with families, and helped us respond more quickly to patients’ needs.

Is palliative care covered by PhilHealth?

At present, PhilHealth has limited coverage for some services related to palliative care, but there is still no comprehensive PhilHealth package dedicated to palliative care across all settings. The good news is that the Department of Health and PhilHealth are working with the Philippine Society of Hospice and Palliative Medicine (PSHPM), Hospice Philippines, and other key stakeholders to expand coverage and improve access to palliative care services.

The goal is to make palliative care more accessible at all levels of care—from hospitals to community and home–based settings—so that more patients and families can benefit from these services. We are hopeful that a broader and more comprehensive PhilHealth coverage for palliative care will become available soon.

“WHAT OFTEN SURPRISES ME IS HOW MUCH RELIEF CAN COME FROM ADDRESSING SUFFERING HOLISTICALLY—NOT JUST PHYSICAL SYMPTOMS, BUT ALSO EMOTIONAL, SOCIAL, AND SPIRITUAL CONCERNS.”

What is the most rewarding or surprising moment you’ve experienced while helping a patient find peace and dignity in their final stages of life?

One of the most rewarding aspects of palliative care is helping patients fulfill their wishes and maintain their autonomy, even in the final stages of life. It can be something as simple as spending meaningful time with loved ones, returning home, or having the opportunity to make important decisions about their care. Seeing patients regain a sense of control and dignity during such a vulnerable time is incredibly meaningful.

What often surprises me is how much relief can come from addressing suffering holistically—not just physical symptoms, but also emotional, social, and spiritual concerns. Sometimes, a heartfelt conversation, family reconciliation, or simply being heard can bring as much comfort as any medication.

It’s also deeply fulfilling to support not only the patient but also their family and even the healthcare team caring for them. Helping everyone navigate this journey together and ensuring that the patient’s dignity is preserved until the very end is one of the greatest privileges in palliative medicine.

^{*Section Head – Supportive, Hospice and Palliative Medicine, East Avenue Medical Center ● Member, Board of Trustees – Philippine Society of Hospice and Palliative Medicine ● Palliative Medicine Consultant: The Medical City – Ortigas, Manila Medical Center, Lung Center of the Philippines, Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium, and UERM}