End of life care: history and the role of the obstetrician and gynaecologist

In obstetrics and gynaecology we care for women who will die during pregnancy, for women who have fatal diseases such as autoimmune diseases or renal, liver, or cardiac failure where our care is tangential but critical to palliation, and for women dying with gynaecological malignancies. Understanding the history of the development of hospice and palliative care, as well as the ethical framework for these choices, may allow us to understand better the difficulties we face in our modern settings in making the choice to turn our goals from prolonging life to maximal comfort on the path to death. Obstetrician gynaecologists have a responsibility to be a voice of advocacy for maximal palliative care for not only the women they care for, but also for women worldwide because of their diminished social status and poverty.