On death and dying: a dignified death is everyone’s right

This article was exclusively written for The European Sting by Ms. Isabelle Gualberto Souza, a 22 years old, 3^rd year medical student at Centro Universitário FIPMoc from Montes Claros, Brazil. 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.

The only certainty we have in life is that we will die someday.

            Thus, discussing death and all the issues related to it is fundamental for the construction of the idea of ​​dignified death for all. In this perspective, palliative care is essential so that, based on the understanding that death is a natural process, inherent to all, we can, as students and health professionals, maintain this social movement giving the terminally ill patient the right to have a life and death with dignity.

            Nowadays, the current focus of medicine is based on the idea that the doctor must know how to diagnose, treat and prevent diseases, since contemporary medicine is guided by the idea of ​​“cure”, based on a rational, non-emotional and scientific model of medicine.

            This whole idea falls apart when the professional faces patients whom there is no chance of cure and death is an inevitable destiny. How to deal with a patient that I can’t cure?

            It is in this scenario that palliative care appears as an outlet for these patients, promoting quality of life for them and their families, through the prevention and relief of suffering.

            However, when we think about universal health coverage, what we see are insufficient investments to access this care practice to reach the entire population, being restricted to patients who can afford the costs. In this sense, what we perceived is a great inequality of access opportunities, with patients with less favored financial and social conditions being unable to have full access to palliative care, making it difficult to reach equity in health services.

            That’s why it is essential to join efforts in an attempt to include palliative care as an essential service in universal health coverage. The inclusion process must start from medical training with the insertion of classes to discuss life terminity and palliative care in the curriculum of medical courses, in addition to broader measures such as the allocation of resources for the development of palliative care services at all levels of health care and for all people in need.

            However, the current reality is that there is still a long way to go before health systems are able to offer access to palliative care at the end of life on an equal basis for the entire population because this type of assistance requires the construction and implementation of effective and appropriate practices that articulate services at all levels of health care, and the biggest part of the health systems around the world do not have structures to offer this type of service to the population, since they continue to be guided by the idea that health services are fundamentally curative.

            To summarize, a dignified death is everyone’s right, and we will only achieve this when we are able to reduce inequalities in the access to health systems and when we understand that living well is health and that dying well is health too. 

References

1. Tamada JKT, Dalaneze AS, BoninI LMM, Melo TRC. Relatos médicos sobre a experiência do processo de morrer e a morte de seus pacientes. Rev Med. 2017; 96(2):81-87.
2. Floriani CA, Schramm FR. Moral and operational challenges for the inclusion of palliative care in primary health care. Cad. Saúde Pública. 2007, 23(9):2072-2080.

About the author

Isabelle Gualberto Souza is a 22 years old, 3^rd year medical student at Centro Universitário FIPMoc from Montes Claros, Brazil. She’s a member of the Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS of IFMSA Brazil UNIFIPMoc since 2020.  She is a scientific research enthusiast and is currently a volunteer fellow in the scientific initiation program of her institution, developing research in the areas of public health and microbiology.  In addition, she is interested in issues about sexual health, maternal health, humanized medicine, care of the elderly and palliative care.