Palliative care, as defined by the World Health Organization, “improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social or spiritual. The quality of life of caregivers improves as well”.
The focus on the quality of life depends on the changeover of the concept of health from the biomedical model to the biopsychosocial model. The first one assumes that health is simply the absence of desease, while the biopsychosocial model refers to the importance of the overall well-being of the person: in that sense, it’s possible to term the quality of life as an important adding factor, considering the central role of the person (Matteucci, 2014).
Palliative care approach introduces the medical humanities which are rooted in the individual’s centrality. This approach wants to humanize the cure, considering the patient as person, instead of a machine-body, and with the objective of offering the best quality of life to who is suffering, even in proximity of death (Testoni, 2015). In this regard, palliative care refers to the concept of health in its entirety, committing itself to maintaining the person’s overall well-being, despite his physical health being compromised. In addition to the complexity given by the difficulty in achieving well-being in terminal patients, palliative care collides with the complexity of the multidisciplinary approach that constitutes it (Pellizzari, Hui, Pinato et al., 2017).
Palliative care build the therapeutic relationship on the principle of truth telling, respecting dignity and self-determination right of the person, in order to improve both the well-being of the patient and of who takes care of him. The non-compliance by the doctor, or by the healthcare staff, in these principles, acknowledged by the law n. 38/2010, means not to recognize the terminal patient as a person, who deserves dignity and self-respect, despite the need of being helped going through the most dramatic passage of his life (Testoni, 2015). In Italy, there is a lack of relational competence demonstrated by the healthcare staff, caused by the compassional idea of the terminal condition and the suffering state itself: “Ignoring the condition of gravity and the imminence of death can give the impression of reducing the level of suffering, because it keeps alive the hope that everything can return to normal. The problem consists precisely in deeming the representation of pain useless, when instead in itself it can be the bearer of crucial meanings” (ibidem). Our current society makes impossible to answer to the essencial questions about suffering, but it is necessary to do it, in order to understand how pain is useless or if it’s indispensable to re-define its meaning (op. cit.).
In this sense, palliative care always offers an interest, even at the end of life, which could be both the relational presence of the doctor and health care staff, or a reflection on the acceptance of pain, or, at least, a way to reduce physical pain; even when everything seems to be coming to an end.
Bibliography
Matteucci, I. (2014). Comunicare la salute e promuovere il benessere. Franco Angeli.
Pellizzari M., Hui D., Pinato E., et al (2017). Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in northern Italy. Support Care Cancer, 25, 1201–7
Powell R. A., Schwartz L., Nouvet E, et al. (2017) Palliative care in humanitarian crises: always something to offer. The Lancet, 389, 1498-9
Testoni, I. (2015). L’ ultima nascita. Psicologia del morire e «Death Education». Bollati Boringhieri.
Comments are closed