Privilege and dignity in type of care former first lady received

April 16, 2018
Former first lady Barbara Bush
Former first lady Barbara Bush attends the First Ladies Conference in 2012. U.S. National Archives photo

Russell Jeffrey Seymore, M.D., part of the Palliative Care Program at MUSC Health, helps people manage the symptoms of serious illness. Some are at the end of their lives, but others are not — they may have many years ahead and may even recover.

Comfort care, which former first lady Barbara Bush is now getting, is for people at the end of life. She’ll no longer receive medical treatment designed to prolong her life. Instead, the focus will be on treating any pain she has and making her as happy as possible. Bush, 92, suffers from congestive heart failure and chronic obstructive pulmonary disease.  

Here, Seymore, who has long admired the wife of former President George H.W. Bush, discusses what may lie ahead for her in his own words.


Having followed her life over the years, back when her husband was president and knowing that she’s been a very involved and active person, both for her family and for our country, I was sad. The clinician in me understands that it means her medical problems and burdens have increased to a point where further medical interventions and hospitalizations and likely blood draws and X-rays aren’t going to be beneficial for her.

It means that instead of doing all that, she’s going to be in an environment, at least in her home or perhaps in a facility, where it’s all going to be about comfort. It’s going to be making sure that on a very basic level, she’s warm, safe, dry and comfortable. She’ll be surrounded by people who care for her and have the expertise to make sure, above all other things, that she’s comfortable. She’ll be able to eat when she wants to eat — there will be minimal restrictions on what that might be.  

She will have medicines, either scheduled or offered to her, that will allow her to have any pain or discomfort treated. If she’s nauseated or itching or short of breath or any of that, that those issues can be dealt with.  On a real basic level, if she just wants to be left alone to sleep and nap and wake up and interact and talk with people more on her schedule than anyone else’s, she’s going to be afforded that privilege and that dignity.  I’m sure that the decision was really well thought out.

It’s a very compassionate decision. It’s very difficult, but here at MUSC Health, it’s done methodically and incrementally.  Once the decision is made, patients and families typically respond very positively to it, because they’ve reached some level of peace with the situation at hand and they have been able to sort out in their own minds what’s really important for this day and in the days to come.  

Most of us in our lives are very focused on the future – planning for the future and living in the future, to an extent. But a decision to go on comfort care, I think, is a recognition on the part of the family and the patient that we really need to be living in the moment and really need to be focusing on what is going to make Barbara Bush feel good today. Anything that would make today better.