The scope of palliative care
Palliative medicine is intended for persons suffering from a progressive chronic pathology that is terminal. Its scope extends from neonatology to geriatrics. It provides special expertise in the medical problems of incurable illnesses. Practitioners of palliative care accept being confronted with the suffering of those with an incurable illness and attempt to provide the most appropriate response possible to it.
The person cared for is at the centre of the care issues
The key element in the palliative approach is the inclusion of the medical demand within a comprehensive approach that identifies suffering and quality of life as multidimensional concepts. The practitioners of palliative care acknowledge the person cared for in his uniqueness, his biographical, cultural and social context. Listening and respect for the autonomy and physical and moral integrity of the vulnerable person constitute the central focus in the practice of Palliative Medicine. The practitioners of palliative care adhere to ethical principles with regard to healthcare that advocate informing the patient, taking account of his own pace, and respecting the person in all the phases of his life.
Palliative care teams function in an interdisciplinary way
The term interdisciplinarity signifies that the act of care dispensed by the care team represents not only the sum of the contributions of each of its members, but rather their conjunction resulting from their complementary nature, criticism and mutual interaction. This method of functioning represents an important vehicle for ethical considerations. Ethical questioning elicits the recommendations of the different persons on the care team, and the dialogue is maintained until all opinions have been expressed and debated. This intercommunication, which involves confrontation of the different values of those involved, obliges them to deploy the arguments for their respective positions. It allows the patient to avoid the subjectivity of a single viewpoint, a particular background, and it allows the caregivers to develop a shared and responsible ethical position during their difficult confrontation with the suffering and death of their patient.
The model of continuing care strives to avoid certain biases in curative care and palliative care. It involves a multidisciplinary approach that interconnects medical, social, psychotherapeutic and spiritual concepts in the broad sense, in a continuum from the news of the severity of the illness to the end of life, without interruption. Continuing care is neither medical overinvestment nor a dogmatic idealisation of “dying well”. It is opposed to an abrupt break between curative care, which focuses only on the efficacy of the treatments, and palliative care, understood as “terminal care”. The patient has a desire to live, a need to be heard, and needs for relief that must be respected. Continuing care allows in particular flexibility in the therapeutic plan that respects the medical as well as psychological evolution of the patient until the extreme end of life, when one then speaks of terminal care. Ethical considerations occupy an important place in this. Because end-of-life situations generate questions and uncertainty, ethics is essential. It provides no ready-made response but a consideration that allows symbolic representation of the issues. Continuing care allows a temporal aspect to be created by taking into account the history of the patient and of the institution, and a spatial aspect through the evaluation of the various possible locations for the end of life (hospital unit, palliative unit, home care, etc.) and the relations among the various care teams.
The philosophical choice of continuing care practitioners is a choice for comprehensive solidarity.
Oxford Textbook of Palliative Medicine », Doyle, Hanks, Mac Donald. Oxford Médical Publications, Oxford, New Tork,1994.
Déclaration de Lisbonne de l’Association Médicale Mondiale sur les Droits du Patient. Adoptée à Lisbonne 1981, amendée à Bali, 1995.
Convention on Human Rigths and Medicine, council of Europe, Strasbourg, 1996.
Archives de l’éthique clinique. Au chevet du malade : analyses de cas à travers les spécialités médicales, David Roy, Centre de Bioéthique. Institut de Recherche Cliniques de Montreal, 1994.
This statement, drafted in 1997 when the Brussels Federation for Palliative Care was founded, is fundamental to our Association.
It allowed the pioneers in palliative care to go beyond philosophical and religious divisions to focus on the values they had in common.
Today, this statement that advocates a concept of continuing care- integrated care and ethical consideration remains thoroughly modern !