Addressing Therapeutic Nihilism in Alcohol-Related Liver Disease: A Hepatology Perspective to Terminal Illness and Palliative Care

ABSTRACT Alcohol-related liver disease, in the context of incurable alcohol dependency, is a terminal disease. Liver specialists are accustomed to watching patients die, both young and old, and this may erode their perceived primary responsibility to extend life. It is common for nihilism to set in, with the risk that this colors the assessment of future patients. This opinion article explores this phenomenon through representative, anonymized cases and the author’s own psychological response. He proposes that therapeutic positivity must be maintained, and that a refreshed attitude to patient care can be found through the acceptance that patients in this cohort are terminally ill, thus invoking the need to consider and access palliative care. Hepatologists must continue to find a balance between advocating for an aggressive approach to therapy (e.g. escalation to critical care, transplantation) in selected cases, while being poised to recommend supportive and palliative pathways when there are indicators of futility. To provide this, hepatologists may require upskilling later in their careers. Embracing palliative care is clearly of benefit to patients, and this article identifies it as way of maintaining engagement among doctors.