ESF Research Conference on BIOMEDICINE WITHIN THE LIMITS OF HUMAN EXISTENCE Doorn, April 2005 Daniel Serrão, M.D., PhD Porto – PORTUGAL NATIONAL COUNCIL OF ETHICS FOR THE LIFE SCIENCES

First Doctor’s Duty ● Recognise the terminal state of the patient – scientific and technical decision ● After this decision any form of curative intervention is futile and ethically unacceptable ● The obsession of intensive care of terminally ill patients is paving the way to euthanasia

Second Doctor’s Duty ● Change from cure to care, from curative medicine to palliative medicine ● Honour to Dame Cicely Saunders and Hospices Movement in U.K. as founders of modern palliative care

The Palliative Care – W.H.O. ● Is the active total care of patients whose disease is not responsive to curative treatment ● Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount ● The goal of palliative care is achievement of the best possible quality of life for patients and their families

The Palliative Care ● The focus is on total pain Physical – Mental – Social – Spiritual ● A pluridisciplinary team is mandatory ● Places – Familial domiciles - Palliative care units - Separate rooms in General Hospitals

The Palliative Care ● Palliative care is itself a compassionate response to the suffering of end-of-life patients ● Is a way of living well until death ● Is not “soft” euthanasia when treating correctly the physical pains

The Palliative Care ● Euthanasia is not a solution to the problem of suffering is the destruction of the sufferer ● Kill by compassion Is Kill the compassion ● Mercy killing Is The killing of mercy

The Palliative Care ● “In a World in which technology threatens to undermine our sense of worth and meaning, hospice has appeared with the promise of not only easing the course for those who must die, but also of restoring the fundamental familial and religious ideals that have nourished our civilization” Hospice: the living idea Fulton R. and Oven G

The Palliative Care ● “The act of deliberately ending of the life of a patient, even at the request of the patients or close relatives, is not part of palliative care nor should it be part of health care practice” Steine Husebö Jour. Pall. Care 1994, 10-2, 80-81