Relevance of palliative care in current medicine and Universal Health Coverage

This article was exclusively written for The European Sting by Ms. Luana Izabela Azevedo de Carvalho and Ms. Mariane Marques Queiróza, two second year medical students at the State University of Amazonas (UEA), Amazonia, 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 writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Palliative care is the comprehensive care of those with serious or life-threatening illnesses. The intent of this type of care is to balance disease intervention with modalities that enhance wellness, supporting the patient and family to cope with advancing illness or rigors of treatment, promoting quality of life, even when cure is not feasible¹. This approach requires the interdisciplinary effort of health care professionals to address the physical, psychological, social, spiritual, and practical supportive needs of patients and their families. The main objective of this method is to inform the patients and family members about the disease, to give support and guidance on the care to be provided. As consequence, a bond trust is created between they and the professional team.

Given the importance of palliative care, it is necessary that they be included in The Universal Health Coverage (UHC), which allows that all individuals and communities have access to the services provided by the primary health care without suffering from financial hardship. From this perspective, UHC also ensures people receive comprehensive care, ranging from promotion and prevention to treatment and rehabilitation².

One of the main challenges that prevent the inclusion of palliative care in the UHC is learning to deal with losses in an environment where cure and prevention of the disease predominate, causing difficulty in the treatment and monitoring of patients with severe suffering and in terminal phase. This happens because treating an individual whose death cannot be prevented was not part of the training of doctors and is often seen as a failure by the community. But the ethical imperative to save lives does not need and should not conflict with the ethical imperative to provide comfort and symptom relief ³.

Although this scenario is contested by the multiprofessional team responsible for palliative care, the most important is the balance between treating the disease and the patient’s biography, wishes and family. Due to this duality, palliative care is inserted in the code of medical ethics in some countries, such as Brazil.

Even so, palliative care does not cover the entire population, especially those in poverty, since it requires a lot of financial resources. In addition, with the coronavirus pandemic, many patients and their families will need palliative and end-of-life care, especially in places where there are few hospitals and few health resources⁴. In humanitarian crises in general, the existence of care gaps, lack of specialized professionals or inadequate service provision is common, with a greater focus on saving lives, to the detriment of pain relief and physical, psychological, social and spiritual symptoms. Palliative Care, in turn, can help to fill these gaps.

With the UHC fundamentals of humanitarian aid, with a focus on the health of populations, in addition to protecting people from the financial consequences, palliative care must be inserted by UHC. This approach will cover care for all populations, in all settings, from terminal illnesses to pandemics. In this way, the disabled and their families will be educated about death in a more dignified way.

References

1. L. TWADDLE MARTHA, et al. Palliative Care Benchmarks from Academic Medical Centers. JOURNAL OF PALLIATIVE MEDICINE. 2007 Feb 13:86-98.

2. De Negri Filho Armando Antonio. UHC – Universal Health Coverage – avanço ou retrocesso na luta pelo direito humano à saúde? Uma contribuição ao debate político-ideológico da guerra de posições entre comunidades epistêmicas no campo da saúde global [Dissertação apresentada com vistas à obtenção do título de Mestre Modalidade Profissional em Saúde Pública.] Escola Nacional de Saúde Pública Sérgio Arouca; 2014.

3. Brugugnolli Izabela Dias, et al. Ética e cuidados paliativos: o que os médicos sabem sobre o assunto?. Rev Bioética. 2013 Mar 21:477-485.

4. EF Tritany, et al. Fortalecer os Cuidados Paliativos durante a pandemia de Covid-19. INTERFACE. 2020 Dec 04:01-14.

About the author

Luana Izabela Azevedo de Carvalho is 19 years old, second year medical student at the State University of Amazonas (UEA), Amazonia, Brazil. She is local director of The Standing Committee on Human Rights and Peace at IFMSA UEA. She also volunteers in the Vascular Surgery Outpatient Clinic.

Mariane Marques Queiróz is 20 years old and is in the second year of medicine at the State University of Amazonas (UEA). She is a local coordinator at IFMSA UEA. She also a collaborator at a research on breast findings in transsexual and transvestite  women at oncology control center of the state of Amazonas.