The practice of medicine can make a sick person well again.

But if there is no chance a patient will get well, medicine can make a dying person comfortable enough to enjoy the last days.

Palliative care treats the symptoms of terminal illness so the patient can tie up loose ends and spend quality time with loved ones without suffering.

The focus of medical treatment at this stage turns from care to comfort, said Linda Logue, coordinator of Sharon Regional Health System's hospice program. She emphasized that while palliative care does nothing to prolong life, it does not shorten it either.

"We don't think of death as a natural process anymore," Ms. Logue said. "We can treat and treat and treat ..."

"It's inevitable. Death is a part of life. It's an art knowing when to push and treat aggressively and knowing when it's time to stop," said Dr. George Garrow, medical director for oncology at Sharon Regional Health System's Cancer Care Center in Hermitage.

Palliative care and hospice go hand in hand.

"When a patient is in hospice, we're not going to do anything to actually treat the illness. We focus on symptoms," Garrow said

The decision to stop treatment and to turn to palliative care grows out of conversations among terminally ill patients, their families and their physicians about where the disease is heading, Garrow said.

"It's surprising for a lot of folks that patients usually are very content and welcome this discussion. In many instances it's almost a relief," said Garrow. "You can really focus on the quality of life and palliating symptoms."

Garrow said the decision to enter hospice or choose palliative care is an individual choice, and each patient is different. He said decisions are often easier on the patients than they are on the families.

"What I often emphasize to patients' families, as aggressively as I treated the symptoms, we want to make sure they're at peace," he said.

At a certain stage in a terminal illness, aggressive treatment such as chemotherapy or radiation can hurt more than it can help.

"If that trade-off is more harmful than good, they shouldn't continue," Garrow said. "If the benefits are worth the risks, if the patient is still strong and still eating, I'll continue with chemotherapy. If it makes them weaker, I stop."

Although chemotherapy is most commonly used to fight cancer, it can also be used in palliative care. If a cancer has metastasized -- spread to other parts of the body -- chemotherapy can lessen the burden of a tumor on a patient's system, Garrow said.

Pain, nausea, shortness of breath, anxiety, weakness and fatigue are common symptoms that palliative care can relieve. Strong pain medications are often used.

Keeping symptoms under control helps a patient spend more quality time with family and friends.

Garrow said that while the decision to undergo palliative care is the patient's, doctors grant a patient's wishes within reason.

"Occasionally a patient is not ready to stop receiving chemotherapy. When I think treatment could be futile and could shorten their life" we suggest the treatment stop, he said, adding, "fortunately, those situations don't happen often. Sometimes if I'm uncomfortable and I feel the patient would be better off (with someone else) ... I try to help them find someone who might continue if ethically or morally I'm uncomfortable."

He added that many people fear that palliative care actually hastens death, and some patients ask to die. Palliative care is not intended for that.

"When I hear a patient ask for something to end their life, it's a signal they're suffering. I take that as a message to ask, what is not worth living for?" Garrow said.