Why does death prefer to hold a scythe rather than my hand?

This article was exclusively written for The European Sting by Ms. Najuah Sael Basheer Atari and Ms. Gabriela Sulzbach Solanho, two 3rd year medical student at Universidade Positivo-Curitiba from Paraná, Brazil. They are affiliated with 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.

Universal Health Coverage (CUS) is a system that guarantees minimum living conditions without the need of a financial cost on the part of the population. It should cover treatments for heart failure, AIDS (Acquired Immunodeficiency Syndrome), depression, diabetes, among other comorbidities. It is a fact that CUS is unable to bear with absolutely all diseases. However, a fact is placed in check, followed by a paradox: According to the World Health Organization (WHO), half of the world population does not have access to CUS, but 100% of the population has a finite life. So why is the greatest certainty in the universe not covered in a concrete way within the CUS, much less covers the entire population?

So to defend for the terminality of life to be included in the minimum health criteria, palliative care (CP) is conceptualized: a multidisciplinary and comprehensive care for patients with an incurable disease. In other words, working with CP is also to develop comprehensive health care, as it is based on the totality of the individual: in its physical, psychological, social, economic and family aspects (and isn’t that also the meaning of CUS ?!).

So for PCs to be included in the CUS, it is necessary a multidisciplinary team working on behalf of the individual in order not only to ensure better relief from suffering, but also to awaken the philosophical feeling of finitude of life, since from the moment that understands the inevitability of death, if it lives with more quality and more intensity, studies indicate that this type of lifestyle prevents depression, heart disease, among others. In other words, even if the CUS is burdened with costs, covering PCs can relieve some of these inputs!

In fact, for the process of dying without pain to be seen with more priority, it is necessary to include this agenda in health schools (and especially medical schools) during clinical practice. Because it is also emphasized that the function of medicine is to save lives, as if dying was a failure or an error, when in fact it is the only absolute certainty. Little is taught at university about pain relief, but much is emphasized about the doctor’s herculean power. This creates professionals who practice medicine to feed their own ego, and not for the relief of human suffering (this being, paradoxically, part of Hippocrates’ oath).

In addition, for this inclusion to exist, it is necessary that government entities exercise their role of representation and start to guarantee this aggregation as a priority. So there is a need for the political awakening of the population to exercise their citizenship more humanely. Many vote to improve the current situation in the country, but that is not enough, it is necessary to vote beyond the present, vote to live and even die better. Living well is a political act, dying with dignity is a revolutionary act.

About the authors

Najuah Sael Basheer Atari, 23 years-old student 3rd yead medical student at Universidade Positivo-Curitiba, from Paraná, affiliated with IFMSA-Positivo in 2019. She believes in equality of gender and a medicine based in evidence and humanity and palliative care. That’s 3 points is not only her ideals, but also the minimal condition for a better world.

Gabriela Sulzbach Solanho, 19 year-old student 3rd year medical student at Universidade Positivo-Curitiba, from Paraná, affiliated with IFMSA-Positivo in 2019. She is a member of Cancerology Academic League of Curitiba and local coordinator of IFMSA Brazil Positivo. In addition, she is interested in issues about humanized medicine, palliative care in a view beyond death, besides scientific initiation