Tens of millions of people die every year in the world. And many of them are experiencing terrible suffering. Palliative medical care is designed to improve the quality of life of people suffering from various forms of chronic diseases in the terminal stage, when all the possibilities of specialized treatment are already exhausted. This area of health does not aim to achieve long-term remission or extend life, but does not shorten it. The ethical duty of healthcare providers is to alleviate the suffering of a sick person. Everyone who has an active progressive disease and is approaching a life line is given palliative care. The main principle: no matter how severe the disease, you can always find a way to improve the quality of human life in the remaining days.
To the question of euthanasia
Palliative care does not accept euthanasia mediated by a doctor. If the patient asks for this, it means that he suffers great suffering and needs better care. All actions are aimed precisely at alleviating physical pain and eliminating psychosocial problems, against which such requests often arise.
Targets and goals
Palliative care affects many aspects of the life of terminally ill people: psychological, medical, cultural, social, spiritual. In addition to stopping pathological symptoms and relieving pain, the patient also needs moral and psychosocial support. Help is also needed for the patient’s relatives. The term "palliative" is derived from the Latin word pallium, which means "cloak", "mask". This is the whole point. Palliative care for cancer patients, people with other serious ailments is aimed at smoothing, hiding, masking the manifestations of an incurable disease, figuratively speaking, covering with a cloak, cover and thus protect.
History of development
A group of experts in the seventies of the last century organized a movement for the development of palliative care under the supervision of WHO. In the early eighties, WHO began to develop a global initiative to implement interventions that would ensure the availability of apioids and adequate pain relief for cancer patients around the world. In 1982, a definition of palliative care was proposed. This is a comprehensive support for patients whose diseases can no longer be cured, and the main goal of such support is to relieve pain and other symptoms, as well as solve the psychological problems of the patient. Soon, this area of health adopted the status of an official discipline with its own clinical and academic positions.
Modern approach
Palliative care in the 1982 definition was interpreted as support for those patients for whom radical treatment is no longer applied. This wording narrowed this area of health to care provided only in the last stages of the disease. But today it is already a universally recognized fact that support of this nature should extend to patients with any incurable disease in the terminal stage. The change appeared due to the understanding that the problems that arise at the end of the patient’s life, in fact, arise in the early stages of the disease.
In 2002, due to the spread of AIDS, the continued growth in the number of cancer patients, and the rapid aging of the world's population, WHO expanded the definition of palliative care. The concept began to apply not only to the patient himself, but also to his relatives. The object of help is now not only the patient, but also his family, which after the death of a person will need support in order to survive the severity of the loss. So, palliative care now is a direction of social and medical activity, the purpose of which is to improve the quality of life of terminally ill patients and their families by alleviating and preventing suffering through the relief of pain and other symptoms, including psychological and spiritual ones.
Basic principles
According to the definition, palliative care for cancer patients and people with other incurable diseases:
- affirms life, but at the same time considers death as a normal regular process;
- designed to provide the patient with an active lifestyle for as long as possible;
- Does not intend to shorten or extend life;
- offers support to the family of the patient both during the course of his illness, and during the period of experiences of bereavement;
- aims to satisfy all the needs of the patient and his family members, including the provision of funeral services, if necessary;
- uses an interprofessional approach;
- improves the quality of life and positively affects the course of the patient’s disease;
- can prolong life with the timely implementation of activities in conjunction with other treatment methods.
Directions
Palliative care is provided in two ways:
1) to ease the torment of the patient along the course of the disease;
2) show support in the last months and days of life.
The leading components of the second direction are the provision of psychological assistance to the patient and his family members, the formation of a special philosophy. As we have said more than once, palliative care is the deliverance of a dying person from suffering. And what is suffering made of? This is pain, and the inability to self-service, and the limitation of life, and the inability to move, and guilt, and fear of death, and a feeling of helplessness, and bitterness due to unfulfilled obligations and unfinished business. The list can be continued for a long time ... The task of specialists is to develop a patient's attitude to death as a normal (natural) stage of the human path.
Organization of Palliative Care
Following WHO's definition, care should begin from the moment a diagnosis is made of an incurable disease that will inevitably lead to death in the foreseeable future. The more correctly and quickly the support is provided, the more likely it is that its main goal will be achieved - the quality of life of the patient and his family members will improve as much as possible. As a rule, at this stage, palliative care for children and adults is provided by the doctors involved in the treatment process.
Direct hospice care is required when a radical treatment has already been carried out, but the disease progresses and takes on a terminal stage. Or when the disease was discovered too late. That is, we are talking about those patients whom doctors say: "Unfortunately, we can not help." It is at this time that the hospice support is required, in other words, help at the end of life. But it is necessary only for those patients who experience suffering. Although it is difficult to imagine a dying person who is not at all worried about this. But maybe there are some ...
Groups of patients in need of help
- people with malignant formations of the fourth stage;
- patients with AIDS occurring in the terminal stage;
- people with progressive non-oncological chronic diseases having a terminal stage of development (pulmonary, renal, heart, liver failure in the stage of decompensation, complications of circulatory disorders in the brain, multiple sclerosis).
Hospice care is provided to those whose life expectancy does not exceed three to six months, when it is obvious that treatment attempts are no longer feasible, when the patient experiences symptoms that require special care and symptomatic therapy with the use of special knowledge and skills.
Support Forms
The procedure for providing palliative care may be different. Each country develops its own plan. WHO recommends providing support in two ways: in the hospital and at home. Specialized institutions where palliative care is provided are hospices and departments based on oncology dispensaries, general hospitals, and social protection hospitals. Support at home is provided by specialists of field services, acting as independent structures or as units of medical institutions.
Since most people prefer to spend the rest of their lives at home, the development of the second option of palliative care seems more appropriate. However, in Russia the overwhelming majority of such patients die in hospitals, because at home relatives cannot create the conditions for their maintenance. In any case, the choice remains with the patient.