The inclusion of Palliative Care in the Universal Health Coverage (UHC) in Brazil

This article was exclusively written for The European Sting by Ms. Jaquelini Fernanda Gomes dos Santos and Mr. Jhonatan Guilherme Fernandes, two 3rd year in medical school, member of the local committee of IFMSA Brazil-Uningá. 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 writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

In the work of Sophocles, from Greek mythology, Oedipus decipher the enigma of the sphinx making an allusion to the human condition from childhood to old age. In terms of health, all ages, according to their needs, should receive quality care in search of full health. In view of this, Universal Health Coverage (UHC) was shaped through negotiations by the World Health Organization (WHO) with the World Bank (WB) and the Rockefeller Foundation, becoming a goal in the Sustainable Development Goals (SDGs) for the 2030 agenda (STECKEL, 2020).

Thanks to scientific and technological advances, the human being has lived longer, which does not necessarily mean that there has been an improvement in the quality of life in old age or after becoming ill, as the struggle to find a cure leads to a culture of denying death, making health interventions that promote a dignified end of life take second place. Thus, palliative care has been seen as an innovative form of health care and its approach has been advocated by reinforcing comprehensive care, preventing and controlling symptoms of patients facing life-threatening diseases, and should be applied to patients and those involved, such as the family and the health team (GOMES et. al, 2016).

In Brazil, UHC and palliative care are guaranteed by the fundamental principles of the Unified Health System (SUS) of universality and integrality, defending the service to all in a multidisciplinary way. However, even though it is written in Law 8.080 / 90, SUS has difficulty to exercise UHC either due to lack of investments, or due to brazilian continental dimension in which each region has its own characteristics, thus revealing a need for effective decentralization of SUS.

According to the WHO (2019), investments in quality primary health care are the basis for reaching UHC worldwide, as it guarantees improved access to essential health care. The reality is different because, according to the Worldwide Hospice Palliative Care Alliance (WHPCA) (2020), the COVID-19 pandemic caused most governments to cut back on their investments in palliative care. In addition, according to the WB and WHO (2017), half of the world population does not have access to essential health services.

Another way to defend the inclusion of palliative care in UHC is through awareness, such as the International Day of UHC that is celebrated on December 12. With this, investments would not be seen as an increase in expenses, but as a fundamental measure to offer a dignified end of life to patients, understanding that death is a natural process of life.

Finally, it is important to remember that the quality of life of the population must be a priority until the end of their life, as well as the Brazilian federal constitution of 1988 and the current Medical Code of Ethics that emphasize the unethical nature of measures such as dysthanasia, in which the patient receives treatments that only prolong the biological life of the patient, without well-being and dignity (FELIX et al, 2013).

REFERENCES

SÓFOCLES. Édipo Rei – Antígona. São Paulo: Martin Claret Editora, 2007.

STECKEL, Bibiana Mayer. Cobertura universal de saúde: reflexões sobre os sentidos e influências do global para o local. 2020.

GOMES, Ana Luisa Zaniboni; OTHERO, Marília Bense. Cuidados paliativos. Estudos avançados, v. 30, n. 88, p. 155-166, 2016.

BRASIL. Lei nº 8.080, de 19 de setembro de 1990. Lei Orgânica da Saúde. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Brasília, set. 1990.

WORLD HEALTH ORGANIZATION.Universal health coverage (UHC). Available on: <https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)>. Access on 20 dec. 2020.

WORLDWIDE HOSPICE PALLIATIVE CARE ALLIANCE. Palliative Care, Covid-19 and Universal Health Coverage Report. Available on: <http://www.thewhpca.org/resources/item/palliative-care-covid-19-and-universal-health-coverage-report>. Access on 20 dec. 2020.

WORLD HEALTH ORGANIZATION.World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. Available on: <https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses>. Access on 20 dec. 2020.

BRASIL. Constituição (1988). Constituição da República Federativa do Brasil. Brasília, DF: Centro Gráfico, 1988

DE ÉTICA MÉDICA, Código. Resolução CFM nº 2.217, de 27 de setembro de 2018, modificada pelas Resoluções CFM nº 2.222/2018 e 2.226/2019. Conselho Federal de Medicina–Brasília: Conselho Federal de Medicina, 2019.

FELIX, Zirleide Carlos et al . Eutanásia, distanásia e ortotanásia: revisão integrativa da literatura. Ciênc. saúde coletiva, Rio de Janeiro , v. 18, n. 9, p. 2733-2746, Sept. 2013 . Available from <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232013000900029&lng=en&nrm=iso>. access on 22 Dec. 2020. https://doi.org/10.1590/S1413-81232013000900029.

About the authors

Jaquelini Fernanda Gomes dos Santos, 24 years old, 3rd year in medical school, member of the local committee of IFMSA Brazil-Uningá. Jhonatan Guilherme Fernandes, 20 years old, 3rd year in medical school, member of the local committee of IFMSA Brazil-Uningá. These students are academics from Ingá University Center (Uningá) and articulated themselves with the objective of reporting a current problem that has occurred in their country and in the world.