Expanding the care for the quality of life and quality of death

This article was exclusively written for The European Sting by Mr. Misael Cavalcanti Angelim Neto and Mr. Aldo Izidório Santos Filho, fourth year students of Medicine at the University of Pernambuco campus Serra Talhada, 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 (PC) is defined by the World Health Organization (WHO) as an approach that improves the quality of life for patients with serious or potentially fatal diseases and their family members, relieving suffering for both. The WHO, in 2014, estimated that 20 million people worldwide needed this care and despite the demand, the service is scarce and millions of individuals are not benefited. The terminality of life is often not properly assisted through this type of care which already has scientific proof of effectiveness.

Brazil is the only country with a public health system that covers more than 200 million people and, despite this giant coverage, palliative care is still not available to the majority of these users. In the Brazilian context, only in 2018 PC was standardized by the Ministry of Health as part of the Unified Health System (SUS). Now, this service must be available throughout the care network, from primary care to more specialized care. Unfortunately, even with this proposal for universal health coverage, PC is still insufficient. In 2015, The Economist Intelligence Unit reported that Brazil is the 42nd country in the ranking of palliative care initiatives, behind several countries in Latin America, such as Ecuador, Uruguay, and Argentina.

In this context, how can we seek more inclusion of palliative care in universal health coverage? We believe that part of the answer lies in education. Health education is essential, yet we see that some health professionals do not know the PC approach due to lack of introduction during their degrees’ studies or simply lack contact with scientific material demonstrating the effectiveness and positive impact of PC in the quality of life of patients. Hence, through the dissemination of knowledge, it is possible to recognize PC as an essential service in health coverage, as well as to expand advocacy for PC since the beginning, still in the university environment, and equally, fostering specialization and research in palliative care.

Furthermore, we consider that the greater availability of hospital beds and centers for palliative care are extremely important, because from the moment the service is disseminated throughout the territory, greater will be the access by the population and, therefore, greater the improvement for the quality of life and death. Both public and private investments efforts are essential for expanding the service in a coordinated manner, at all levels of care, and in all places. Thus, both physical resources, such as medicines and center for palliative care, and human resources, such as specialized professionals, will have a greater chance of attending and give proper care to larger populations.

Lastly, we trust that the universal expansion of palliative care can also promote a change in the practice of medicine, as these services do not only address the disease but the individual in a multidimensional way. Alongside advocacy for palliative care in universal health coverage, the health systems and professionals will also move towards medicine that understands more about the importance of caring and not just curing.

About the author

Misael Cavalcanti Angelim Neto, student of the fourth year of Medicine at the University of Pernambuco campus Serra Talhada. He is a member of the International Federation of Medical Students’ Associations of Brazil (IFMSA Brazil), acting as President of the Local Committee IFMSA Brazil UPE Serra Talhada and member of the National Team of Public Health of IFMSA Brazil. He shares interests in Public Health believing in the need to promote easier access to better public health systems for all populations.

Aldo Izidório Santos Filho, student of the fourth year of Medicine at the University of Pernambuco campus Serra Talhada and affiliated to the International Federation of Medical Students’ Association of Brazil (IFMSA Brazil), acting as Local Vice President for Internal Affairs of the Local Committee IFMSA Brazil UPE Serra Talhada. He shares interests in studies about mental health, oncology, and the fundamental right of palliative care available for all patients who need this approach.