To Ease Without Curing


Limits on Maintenance and Cure become more difficult to define with the medical community’s increasing reliance on palliative treatment


Palliative care is an increasingly popular approach to treating permanently ill or injured patients. Although not new (palliative care has been around for more than 30 years), the number of providers offering palliative care to their patients has more than doubled since 2000.1


The explosion of palliative


Noreen D. Arralde Claims executive


Patient X is a 59 year old seaman with a history of kidney disease. Recently while working as a wiper, he began to experience fatigue, shortness of breath and swelling of the feet and hands. He was taken to the hospital, where treatment for kidney failure likely saved his life. He is now undergoing dialysis.


The shipowner asks, “What is our maintenance and cure obligation to this seaman?” Good question.


A shipowner is obligated to provide maintenance and cure until such time as an ill or injured seaman is fit for duty or reaches maximum medical cure. A seaman reaches maximum medical improvement when the condition will not improve with additional medical treatment. The fact that a seaman continues to receive palliative treatment does not entitle him or her further maintenance and cure if the condition will not improve.


Patient Y is a 30 year old seaman with no medical history to speak of. Recently while working as a cook, she had several unexplained falls and also reported feeling fatigue, cold, and numbness. She was taken to the hospital and diagnosed with multiple sclerosis. Her symptoms now appear sporadically without warning. Sometimes, her symptoms clear completely, sometimes not. Her doctor wants to put her on a new drug which may slow or even reverse the MS symptoms.


Once again, the shipowner asks, “What is our maintenance and cure obligation in this circumstance?”


care programs poses a quandary for shipowners. While palliative care, which focuses on pain and symptom management, can improve the patient’s comfort and quality of life, must the shipowner pay for it?


Patient Z is a 42 year old deck officer who sustained a permanent brain injury. He suffers from cognitive deficits and muscle spasms. He recently started seeing a doctor who wants to start him on a new rehabilitation regimen which the doctor believes may lessen the muscle spasms and could result in some cognitive improvement, although there is no chance he will ever return to the same condition as before the accident.


Once more, the shipowner asks, “What is our which our maintenance and cure obligation?”


More than sixty years ago, the United States Supreme Court said that shipowners were not required to pay for palliative care under the maintenance and cure obligation. With the medical community’s emphasis today on quality of life care, determining whether a recommended course of treatment is considered palliative and when it is considered curative can be difficult for shipowners and the costs of getting it wrong can be punitive.


In cases similar to the three described above, courts were asked to decide what shipowners were required to pay under the maintenance and cure obligation. In the case of Patient X, the court held that the shipowner was required to pay for dialysis treatment. The court noted dialysis treatment did more than just relieve the symptoms of kidney failure, it allowed the seaman to live a normal life. In the case of Patient Y, the court held that the shipowner was


1 According to Diane E. Meier, MD, Director of the Center to Advance Palliative Care, a national organization based at New York City's Mount Sinai School of Medicine


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