Palliative care: how understanding terminal pain and suffering guarantees the dignity of human rights

This article was exclusively written for The European Sting by Ms. Isabella Arantes Tobbin and Naiany Olivotto Martins, two second year medical students at Universidade Paranaense (UNIPAR) – Brazil. They are 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.

“We all need people capable of understanding our pain and helping us to transform our suffering into something that makes sense”. The phrase in the book “Death is a day that is worth living” by Ana Claudia Quintana Arantes, portrays the difficulties and desire for terminal patients to receive the same attention, even when there is no longer a possibility of cure.

The OMS defines palliative care as assistance provided through a multidisciplinary team that aims to alleviate suffering and improve the quality of life of terminally ill patients and their families. This definition is in line with UHC’s proposal to ensure quality services at affordable prices. The inclusion of palliative care within the UHC, therefore, runs through human rights values.

The COVID-19 pandemic, given the severe clinical situation that some patients evolve, added to the lack of knowledge of health professionals and family members on the subject, evidenced the essentiality of discussing palliative care, which is so necessary at this moment when everything that doctors can do to offer, is to ease the pain. The little seriousness and value with which palliative care is treated goes against what is called for in the Universal Declaration of Human Rights: dignity for all.

Besides that, an interesting fact is that in practice the inclusion of palliative care is financially beneficial. A study by Thomas J. Smith, a professor at Johns Hopkins University, showed that it is possible to save $ 4 million a year through this modality. This occurs since in this way the excessive hospitalization of patients is avoided and consequently unnecessary surgical procedures or that lead to greater suffering for the patient without a prognosis for possible improvement.

On this way, it is essential to create strategies to achieve the notoriety of palliative care. Effective and long-term changes are always on the base. In this context, it is essential that health science courses invest in the teaching of palliative care, going through the recommendations of their need, which patients they fit into and how to proceed comprehensively, since it is essential that patients have a multidisciplinary team for this care.

Another way to include palliative care in universal coverage is to invest in the construction of specific wards for such care in hospitals as well as houses restricted to terminally ill patients, in order to further reduce the costs of inpatient accommodation, providing the offer to a greater number of individuals and with comfort.

In the short term, it is important to promote courses on the topic to health professionals already working, mainly doctors. There is a worldwide tendency for these to specialize more and more in a certain area in order to distance themselves from integrative, holistic medicine that takes into account all aspects of the human being. On this way, palliative care can be integrated gradually and will soon be offered in the hospital daily routine, thus offering an understanding of terminal pain and suffering.

References

1. World Health Organization. National cancer control programs: policies and managerial guidelines, 2nd ed. World Health Organization, 2002. Available at: https://apps.who.int/iris/handle/10665/42494. Accessed on 20/12/2020

2. FLORIANI, Ciro Augusto; SCHRAMM, Fermin Roland. Palliative care: interfaces, conflicts and needs. Ciência & Saúde Coletiva, v. 13, p. 2123-2132, 2008. Available at: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232008000900017. Accessed on: 12/20/2020

3.MATOS, Maria da Conceição Ferreira; SANTOS, Duarte Costa. Evolution of Palliative Care in Europe: Literature Review. 2016. Available at: https://repositorio-aberto.up.pt/bitstream/10216/89668/2/170161.pdf. Accessed on: 12/20/2020

4. Palliative care for inpatients also saves money. Medscape, 2020.

Available at: https://portugues.medscape.com/verartigo/6500522. Accessed on: 12/20/2020

About the author

Written by Isabella Arantes Tobbin and Naiany Olivotto Martins, second year medical students at Universidade Paranaense (UNIPAR) – Brazil. They are passionate about medicine and both were founders and members of IFMSA BRAZIL-UNIPAR.