Palliative Palliative CareCare

What is Palliative Care?What is Palliative Care?

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

What does Palliative Care What does Palliative Care involve?involve?

►Pain and symptom controlPain and symptom control

►Communication and coordinationCommunication and coordination

►Emotional supportEmotional support

► Family/caregiver support Family/caregiver support

Palliative Care:Palliative Care:► provides relief from pain and other distressing symptoms; provides relief from pain and other distressing symptoms; ► affirms life and regards dying as a normal process; affirms life and regards dying as a normal process; ► intends neither to hasten or postpone death; intends neither to hasten or postpone death; ► integrates the psychological and spiritual aspects of patient care; integrates the psychological and spiritual aspects of patient care; ► offers a support system to help patients live as actively as offers a support system to help patients live as actively as

possible until death; possible until death; ► offers a support system to help the family cope during the offers a support system to help the family cope during the

patients illness and in their own bereavement; patients illness and in their own bereavement; ► uses a team approach to address the needs of patients and their uses a team approach to address the needs of patients and their

families, including bereavement counselling, if indicated; families, including bereavement counselling, if indicated; ► will enhance quality of life, and may also positively influence the will enhance quality of life, and may also positively influence the

course of illness; course of illness; ► is applicable early in the course of illness, in conjunction with is applicable early in the course of illness, in conjunction with

other therapies that are intended to prolong life, such as other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage investigations needed to better understand and manage distressing clinical complications. distressing clinical complications.

Palliative Care Vs. Palliative Palliative Care Vs. Palliative ActionAction

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

Main RulesMain Rules

► Respect for the pacient’s Respect for the pacient’s automony (choices);automony (choices);

► Do the right thing for the pacient Do the right thing for the pacient principle of beneficiency);principle of beneficiency);

► Minimize the harm (principle of Minimize the harm (principle of non maleficiency);non maleficiency);

► Justice (careful use of the Justice (careful use of the available resources by the available resources by the physicians)physicians)

Rule of Double Effect

Birth of Palliative CareBirth of Palliative Care

► 19th Century (1968)19th Century (1968)► Cicely Saunders Cicely Saunders ► Hospice MovementHospice Movement► Saint Cristopher’s Saint Cristopher’s

Hospice Hospice ► Portugal – 1990’s by Portugal – 1990’s by

Isabel Galriça Neto Isabel Galriça Neto (Odivelas)(Odivelas)

Who cam be admitted to Who cam be admitted to Palliative Care?Palliative Care?

Pacients with:Pacients with:► No perspective of cure or healing No perspective of cure or healing

treatment treatment ► Chronic diseases Chronic diseases ► Intense pain and sufferingIntense pain and suffering► Limited life expectancy Limited life expectancy

““There’s nothing more i can do...”There’s nothing more i can do...”

Palliative Care TeamPalliative Care Team

► Physicians, nurses, social workers, Physicians, nurses, social workers, psychologists

► Chaplains, massage therapists, pharmacists, Chaplains, massage therapists, pharmacists, nutritionistsnutritionists

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 dignityRight to die with dignity

►The Palliative Care main goal is to The Palliative Care main goal is to make sure that terminal patients end make sure that terminal patients end their lifes (their last days) peacefully, their lifes (their last days) peacefully, surrounded by their families and free surrounded by their families and free from any pain. So, i can say that from any pain. So, i can say that Palliative Care allows a Palliative Care allows a human e human e peacefull death.peacefull death.

► Right to health protection (arts. 64.º ight to health protection (arts. 64.º CRP e 3.º Convenção sobre os Direitos CRP e 3.º Convenção sobre os Direitos do Homem e a Biomedicina)do Homem e a Biomedicina)

► Art. 7.º DL n.º 101/2006, de 6 de Art. 7.º DL n.º 101/2006, de 6 de Junho Junho

►Die with dignity means respecting means respecting patient’s autonomy by the phycisians patient’s autonomy by the phycisians and the rest of the team, respecting and the rest of the team, respecting their wishies and choices.their wishies and choices.

The perspective of The perspective of the patientthe patient

Right to refuse treatmentRight to refuse treatment

► Art. 26.º, n.º 1 CRPArt. 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 Patient's right to self determination in matterdetermination in matters of health care: a s of health care: a patient can refuse the patient can refuse the execution of execution of treatment, even treatment, even if that refusal would if that refusal would result result in danger to his life.in danger to his life.

►Despite the refusal of treatment, patients Despite the refusal of treatment, patients have the right to other kinds of health have the right to other kinds of health care, appropriate to their condition, care, appropriate to their condition, because they can not be discriminated because they can not be discriminated by their aggravated state of health (art. by their aggravated state of health (art. 4.º, al. g) Lei n.º 46/2006, de 28 de 4.º, al. g) Lei n.º 46/2006, de 28 de Agosto)Agosto)

►Physicians have the duty not to perform Physicians have the duty not to perform unnecessary or useless acts in order to unnecessary or useless acts in order to keep the patient alive for a few days keep the patient alive for a few days more.more.

Killing or Letting Die?Killing or Letting Die?

► The killing - letting die distinction has The killing - letting die distinction has been widely used to separate permissible been widely used to separate permissible practices from condemnable practices.practices from condemnable practices.

► Three questions:Three questions:1. What conceptually is the 1. What conceptually is the

difference between killing and letting difference between killing and letting die?die?

2. Is killing itself morally wrong, 2. Is killing itself morally wrong, whereas allowing to die is not itself whereas allowing to die is not itself morally wrong?morally wrong?

3. Is forgoing life-sustaining 3. Is forgoing life-sustaining treatment sometimes a form of killing?treatment sometimes a form of killing?

http://www.youtube.com/watch?v=ttW8pxF__g4

Tânia dos SantosTânia dos Santosn.º 1243n.º 1243