Palliative care: so, how do we want to die?

This article was exclusively written for The European Sting by Ms. Camila Fonseca Carneiro, a fourth-year medical student at the State University of Amazonas (UEA). She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

“By taking care of you at the final moment of life, I want you to feel that I care that you are you,” said Cicely Saunders, a nurse, social worker and physician, in the 1960s. The notion of palliative care has existed since Antiquity with philosophies on the integral care of the human being and continued through the Middle Ages with the installation of inn focused on welcoming lepers, abandoned patients, orphans and hungry people. The contemporary concept of palliative care took shape, however, only in 1967 through the founding of St. Christopher’s Hospice and under the light of  the numerous works bequeathed by Cicely Saunders.

In this context, it is about ensuring quality of life for patients with chronic diseases that have a devastating potential to cause suffering. Oncological pathologies, mainly with late diagnoses, treatments full of side effects and stigmatizing in relation to death, account for a significant portion of palliative care. If, on the one hand, oncology enchants medical students by exponential scientific advancement in recent decades, on the other hand, death remains a neglected topic in medical education. This is due to a cultural act of facing death as a failure of the healthstaff, as well as the collective habit of enjoying the worldly pleasures allied to the fear of the unknown.

It has not been scientifically documented what happens to the spirit after the stop of brain function, nor is there even evidence of what is the spirit. For this reason, there is a psychological and philosophical clash of every human being over the parade of the human tissue system, being more pleasant to remain within the comfort zone without emotionally approaching those who are close to death. In developing countries, the trivialization of death due to the high homicide rate, social inequality and lack of basic supplies such as painkillers and dressings, for example, make palliative care as challenging as rebuilding a nation at war.

According to the World Palliative Care Alliance, a non-governmental organization present in more than 100 countries and composed of about 350 organizational members, 76% of individuals deserving of palliative care are in developing countries; worldwide, 57 million require palliative care and 18 million people die in pain and stress that could be avoided. In view of these numbers, care in the terminal phase of life should be emphasized in the principles of Universal Health Coverage.

It remains, then, to adapt the health structure to the local reality. On the African continent, shamans, volunteers and the nursing team go to the patient’s home unit, offering comforting words and basic medical supplies. The proactive intervention of local organizations in remotely located places, together with scientific production dealing with the health system and culture of underdeveloped countries, are measures that can help in the implementation of a palliative care network centered on the universal health coverage model. Yet, just staying close to those who are prone to die makes us more human.

About the author

Camila Fonseca Carneiro is a fourth-year medical student at the State University of Amazonas (UEA). She is local coordinator and local director of international clinical and surgical exchange at the International Federation of Medical Students’ Association (IFMSA) Brazil UEA. She is a member of the Academic League of Pulmonology and Tisiology of Amazonas and the Academic League of Pediatrics and Neonatology of Amazonas. In 2018 and 2020, she volunteered as president of the electoral table by the Regional Electoral Court of Amazonas.