VATICAN CITY — A group of physicians and other health care
experts are working with the Vatican to promote what they see as a sorely
needed form of "advanced medical care" — palliative care, which is
centered on pain relief and emotional, spiritual and social support of patients
with chronic, progressive diseases.
Under the auspices of the Pontifical Academy for Life, 13 experts
from eight countries spent more than a year developing a "white paper for
palliative care advocacy," which was published in late September by the
Journal of Palliative Medicine, a peer-reviewed publication.
Dr. Carlos Centeno, director of the Atlantes Research Group at
the University of Navarra, Spain, and coordinator of the experts' group, told
reporters Sept. 27 that palliative care is "advanced medicine for the end
of life," a form of medicine that relies less on technology and more on
human contact and a team approach to patient care.
Dr. Thomas Sitte, chairman of a German foundation devoted to
palliative care, said that in his country, "we have a problem with
over-treatment, over-treatment until the very end" of a patient's life.
Often that treatment is aggressive, excessive and painful, which
almost naturally weakens the patient's desire to live and increases the
family's suffering as well, he said. Palliative care is not a soft form of
euthanasia, but it does accept the fact that some illnesses cannot be cured.
Centeno said that in some parts of the world palliative care and
hospice care are nearly identical, especially because "the same spirit is
behind them, the principles are the same: holistic care, family involvement, a
team approach and patient-centered care."
Identifying individuals or categories of people to lobby and
drawing up proposals, the 13 experts first looked to national policy makers,
urging efforts to provide universal access to palliative care.
"Patients with chronic progressive diseases, such as cancer,
congestive heart failure, chronic obstructive pulmonary disease and HIV-AIDS
develop severe physical, psychosocial and spiritual symptoms before
death," they said. Palliative care can reduce much of their suffering, and
"there is strong evidence that these benefits are accompanied by a
reduction in the total cost of care."
The experts called for mandatory undergraduate courses in
palliative care for all medical and nursing studies and for the development of
certification guidelines for health care workers specializing in palliative
care.
They also urged a special role for pharmacists in the
palliative-care team since most patients will need to take multiple drugs and
will have an increased risk of negative drug interactions.
Speaking to reporters, Sitte also highlighted the report's
insistence that governments and hospitals take seriously the World Health
Organization's identification of morphine as an "essential medicine."
"Globally, a majority of patients die with severe pain
without having ever received a single dose of morphine or other opioid
analgesic," the report said. Obviously the "abuse potential and
adverse effects" must be considered and the drugs must be handled with
care, but there is no other drug as effective in treating pain, especially in
patients with cancer.
Governments and health care providers must "recognize access
to pain relief and palliative care as a basic right of the person and the
family," the report said.