Palliative Care versus Euthanasia

What do people think about death today?

Hablar hoy de la muerte no es algo políticamente correcto en nuestra cultura, porque la consideramos como ajena a la vida; como si tan sólo ocurriera por mala suerte o por desgracia. Sin embargo en la realidad la muerte acontece en cualquier momento de la existencia, incluso durante la niñez. La muerte de un ser querido supone un un inmenso dolor y duelo por la separación física definitiva de esa persona tan importante para nosotros. Supone dolor por quien ha fallecido y también dolor para nosotros, que quedamos privados de su presencia.

Terminal illness

It is the proximity of an irremediable death. It is characterized because the dying person has a "holistic or total pain". He/she suffers from physical, psychological, spiritual and social pain.

What is euthanasia?

It is to end the life of a sick person. It is the intentional provocation of the death of a person suffering from an advanced, chronic or terminal disease. This death can be caused by action or omission.

Physicians are pained to see how in so-called advanced societies euthanasia is being introduced to rid society of annoying people who generate costs for the state.

At the same time, we are pleased to see how patients and their families show deep gratitude in those places where Palliative Care and Home Care have been established. In our country they have been implemented in recent years, but there is an urgent need for a broader and more homogeneous development of Palliative Care throughout Spain.

What strategies are used by campaigns advocating the euthanasia law?

Those who defend the euthanasia law use campaigns and mobilizations to stir people's feelings and try to show that it is not possible to "do otherwise". They base themselves on the autonomy of the person, if he/she wishes it. Autonomy that in practice does not exist, because We are all by definition vulnerable and dependent. And in a very special way, in the last moments of life, we are all vulnerable and dependent..

Palliative care

Afortunadamente, la humanización de la asistencia sanitaria y el control del sufrimiento de un enfermo en situación terminal es hoy médicamente posible gracias a la correcta aplicación de los Cuidados Paliativos, que se administran según una guía de actuación basada en unos principios éticos que orientan la toma de decisiones clínicas.

On what ethical principles is the practice of palliative care based?

Principle of solidarity. Solidarity with terminally ill persons and their families implies accompaniment and the application of adequate assistance resources. No one should face his or her own death alone, without essential help from others. This solidarity implies say no to neglect, disinterest and oblivion. It implies saying yes to closeness, to human warmth, to the provision of quality care. Un sí también al alivio del sufrimiento social.

Principle of non-maleficence.

Non-maleficence arises from the Hippocratic ethics with the known, principle of Primum non nocare. Never to harm the suffering human being is a requirement prior to any medical intervention. This implies verifying a correct diagnosis of terminality and avoiding medical measures that will not achieve the desired objectives.

Principle of fairness

It requires offering the same solutions to all patients. Guarantee the rights of the terminally ill patient and his family without discrimination..

For this purpose, it will be necessary to check the adequacy of :

• The structure.
• The capacity of the professionals.
• The process, for the correction of care protocols.
• The results of the terminal phase and the achievement of an appropriate death.
• Applying the principle of fairness also includes assessing the possibility of social futility.

The principle of autonomy

Individuals should be treated as autonomous and persons whose autonomy is diminished should be the object of care. One way of respecting autonomy is to promote in practice the participation of the patient and his or her family in decision-making.

What does this imply?

• Inform the patient and the next of kin in an understandable manner.
• To guarantee the willingness to accept treatment, through the use of informed consent, respecting the right to refuse it.
• Protect minors who are unable to make decisions for themselves, and accept parental decisions.

Principle of beneficence

It requires causing no harm. Maximize possible benefits and minimize possible harm. Palliative Care performs an objective analysis of the benefit-risk ratio, applies a comprehensive multidisciplinary care plan. And apply the final sedation, when it is necessary with a protocol. ethically correct.

Conclusions

In view of the foregoing, I consider:

First, that it is vitally important to awareness at all levelsand individual, medical, medical, social, family and individual, of the radical difference between "palliative care and euthanasia".

Second, that it is vitally important naturalizing and humanizing the final trance of existence, respecting the dignity of the person in each particular case. The most important moment of a person's life is the moment of death.

Thirdly, that the establishment of the law on euthanasia, the application of which is open to errors and misunderstandings, is to be rejected. And yet it is urgent to establish, as soon as possible, a law on palliative care.