Palliative Care

What is Palliative Care? ► Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

What does Palliative Care involve? ► Pain and symptom control ► Communication and coordination ► Emotional support ► Family/caregiver support

Palliative Care: ► provides relief from pain and other distressing symptoms; ► affirms life and regards dying as a normal process; ► intends neither to hasten or postpone death; ► integrates the psychological and spiritual aspects of patient care; ► offers a support system to help patients live as actively as possible until death; ► offers a support system to help the family cope during the patients illness and in their own bereavement; ► uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; ► will enhance quality of life, and may also positively influence the course of illness; ► is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Palliative Care Vs. Palliative Action ► is a therapeutic measure, without curative intentions, that integrates medical practice. It can be done whatever the disease is, and phase of evolution ► Palliative Action is a therapeutic measure, without curative intentions, that integrates medical practice. It can be done whatever the disease is, and phase of evolution

Main Rules ► Respect for the pacient’s automony (choices); ► Do the right thing for the pacient principle of beneficiency); ► Minimize the harm (principle of non maleficiency); ► Justice (careful use of the available resources by the physicians) Rule of Double Effect

Birth of Palliative Care ► 19th Century (1968) ► Cicely Saunders ► Hospice Movement ► Saint Cristopher’s Hospice ► Portugal – 1990’s by Isabel Galriça Neto (Odivelas)

Who cam be admitted to Palliative Care? Pacients with: ► No perspective of cure or healing treatment ► Chronic diseases ► Intense pain and suffering ► Limited life expectancy “There’s nothing more i can do...”

Palliative Care Team Palliative Care Team ► Physicians, nurses, social workers, ► Physicians, nurses, social workers, psychologists ► Chaplains, massage therapists, pharmacists, nutritionists Working together the palliative care team provides: - Close communication; - Expert management of pain and other symptoms; - Help navigating the healthcare system; - Guidance with difficult and complex treatment choices; - Emotional and spiritual support for you and your family.

Right to die with dignity ► The Palliative Care main goal is to make sure that terminal patients end their lifes (their last days) peacefully, surrounded by their families and free from any pain. So, i can say that Palliative Care allows a human e peacefull death. ► ight to health protection (arts. 64.º CRP e 3.º Convenção sobre os Direitos do Homem e a Biomedicina) ► Right to health protection (arts. 64.º CRP e 3.º Convenção sobre os Direitos do Homem e a Biomedicina)

► Art. 7.º DL n.º 101/2006, de 6 de Junho ► means respecting patient’s autonomy by the phycisians and the rest of the team, respecting their wishies and choices. ► Die with dignity means respecting patient’s autonomy by the phycisians and the rest of the team, respecting their wishies and choices.

The perspective of the patient

Right to refuse treatment ► Art. 26.º, n.º 1 CRP : “ ► Art. 26.º, n.º 1 CRP : “Everyone is accorded the rights to personal identity, to the development of personality, to civil capacity, to citizenship, to a good name and reputation, to their image, to speak out, to protect the privacy of their personal and family life, and to legal protection against any form of discrimination.” Patient's right to self determination in matters of health care: a patient can refuse the execution of treatment, even if that refusal would result in danger to his life. ► Patient's right to self determination in matters of health care: a patient can refuse the execution of treatment, even if that refusal would result in danger to his life.

► Despite the refusal of treatment, patients have the right to other kinds of health care, appropriate to their condition, because they can not be discriminated by their aggravated state of health (art. 4.º, al. g) Lei n.º 46/2006, de 28 de Agosto) ► Physicians have the duty not to perform unnecessary or useless acts in order to keep the patient alive for a few days more.

Killing or Letting Die? ► The killing - letting die distinction has been widely used to separate permissible practices from condemnable practices. ► Three questions: 1. What conceptually is the difference between killing and letting die? 2. Is killing itself morally wrong, whereas allowing to die is not itself morally wrong? 3. Is forgoing life-sustaining treatment sometimes a form of killing?

Tânia dos Santos n.º 1243