ABSTRACT
Signals of abuse in families and among caregivers represent a unique challenge in palliative care. The physician must be able to recognize the signs of abuse, be available to the patient and let the patient determine how the physician can help best. In caring for palliative care patients physicians need to be aware of signs of abuse within families and among caregivers. Abusive relationships endure, and can escalate, during these difficult times of dependence and stress. Abuse, whether physical or emotional, denies choice and freedom through the misuse of power and control. As David Loxterkamp eloquently observed: 'In listening to the stories of illness over countless sittings or at the moment of truth, people become attuned to the whispered qualities of a person's life, the essence at risk in the throes of illness. And in so doing, with human presence and the comfort of words, people can help bridge a gulley where the road washed out'.
