Palliative care: an ethical responsibility of health systems

This article was exclusively written for The European Sting by Ms. Nicole Mazzochi, a second-year medical student at Universidade Federal de Santa Maria (UFSM), in southern Brazil. She is 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 writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

WHO defines palliative care as the prevention and relief of the suffering of patients and their families, who are facing problems associated with potentially fatal diseases. Palliative care improves the quality of life, promoting dignity and comfort and may also positively influence the course of the disease. That care has a long list of benefits for the patient, the family and the health system and, therefore, it must be integrated and complementary to the prevention, early diagnosis and treatment of serious diseases or health problems that limit life.

To achieve the Sustainable Development Goal: universal health coverage (UHC), it is necessary to integrate palliative care in public health systems. This care is part of a medical and ethical need that must be accessible to anyone who needs it at all levels of health systems. In this perspective, for the inclusion of palliative care in health systems the first steps should be: a national palliative care policy that requires access for all to palliative care; a national strategic plan to provide this access; inclusion of palliative care in any strategic plans involving cancer, such as sexually transmitted diseases, such as the elderly, pediatrics, HIV and AIDS, drug-resistant tuberculosis and primary health care (PHC).

Palliative care can increase many advantages to health systems, as they improve patient outcomes by preventing and alleviating the most common and serious types of suffering associated with serious health problems. In addition, they reduce costs for the health system, reducing hospital admissions and the length of stay near the end of life.

Furthermore, the integration of palliative care specifically in PHC can generate additional benefits. Since palliative care provided as part of the PHC system can be home-based, the home care services provided can also be expanded. Visiting patients at home presents an ideal opportunity both to ask about the well-being of the home and family and to educate them. Health professionals can be trained to provide education not only on caregiving for the patient, but also, for example, on how to quit smoking, indoor air quality, HIV prevention and the importance of a healthy diet, exercise, prenatal care and cervical cancer screening.

In addition, palliative care can help to fill some needs of the most deprived health systems, such as the lack of mental health services, rehabilitation and long-term care facilities to care for people with severe disabilities and social assistance services.

Lastly, the planning and implementation of palliative care in health systems must encompass the assessment and treatment of the four dimensions of suffering: physical, psychological, social and spiritual. This allows treatment to be centered on local needs and, therefore, adapted to the needs of each patient and their family.

About the author

Nicole Mazzochi is a second-year medical student at Universidade Federal de Santa Maria (UFSM), in southern Brazil. She is the local president of IFMSA Brazil in her university. She is particularly interested in public health, because she believes it can contribute a lot in people’s lives. For her, the perfect medical practice encompasses scientific research, patient-centered care and empathy.