"Palliative care should be a right, not a privilege."Palliative care: comprehensive care when wellness is importantManuel Serrano is the Medical Director of Laguna Care Hospitala palliative care-oriented health center located in Madrid (Spain). Dr. Serrano writes articles, books and gives lectures, but above all, what characterizes his work is "caring for people".
Convinced that palliative care "is a fundamental activity for a physician", and given the importance given to it by the Pope FrancisDr. Serrano talks about them with Omnes in this interview.
When a patient is in palliative care, the physician knows that his mission is no longer to cure, but to care. How does his work change?
- As health professionals, we know that what must characterize us most is caring for people. Curing is not always possible, but caring, comforting and accompanying is always possible. When people become ill, even with a trivial illness, they prefer to have a doctor at their side who is attentive to their needs, to their way of experiencing what is happening to them, who adapts empathetically and compassionately to their pain and suffering. They need first to be reassured at least by a look, then to feel understood, and finally to be offered the treatment that will cure or relieve them and to be concerned about the outcome of their treatment.
In short, the doctor becomes a sincere friend who takes care of a fundamental aspect of life: health, which can often be restored, and sometimes not, but can always be alleviated, accompanied and comforted. And to be aware of this and to live it this way, believe me, is a privilege.
Some people think that palliative care is akin to "playing God" because it unnecessarily prolongs the patient's life. Can you clarify what palliative care is so that we don't fall into this misinterpretation?
- This has nothing to do with reality. Palliative care is a fundamental activity for a physician. In fact, it is always possible, in all circumstances of illness. They bring the physician closer to his fellow human beings, and an activity develops in them that is the fruit of love between people, of the desire to help the other because he is equal to me, because of the human dignity that unites us. Nothing is further from playing God. They are so much a human relationship that I cannot imagine any other more deserving of the name.
On the other hand, palliative care does not prolong life, but rather makes it easier at a time when the threat of the end is approaching, and makes it possible to await that end, which is death, with a calmer and more hopeful attitude. Because we not only deal with pain, restlessness, immobility and weakness, but we also solve as far as possible the patient's problems with social or family formalities, we act in the psychological sphere that facilitates the more or less accepted awareness of what is happening to them, and we also deal with what is an inseparable part of the terminal illness, the accompaniment in the spiritual restlessness.
As a physician, when do you make the decision to move from trying to cure a patient to admitting them to palliative care? How do you avoid therapeutic overkill?
- The sensible treatment of diseases, especially those of a malignant nature, which carry an implicit risk to life, should be put into practice while the disease is under control, without evidence of extension of the disease and without a progressive evolution. Sometimes it is found that everything that is being done or could be done carries an implicit risk greater than the good it is intended to cause, due to side effects or risk of diseases that appear due to the weakness that the treatment often provokes.
The obstinacy in the application of treatments, hoping that one of them may give proof of a certain action, leads to actions outside all scientific evidence and therefore amounts to applying non-innocuous treatments that cause suffering and deceptively offer a hope far from all reason.
When a malignant disease or terminal illness has reached a certain extent, it is important to know that what we need to do is to provide the greatest comfort and well-being to the patient and, within the limits of the human relationship, to help him/her understand that everything humanly feasible has already been done. This is the moment to apply palliative or comfort care.
How can we look at patients as people, without reducing them to their disease?
- The first thing we teach in medical school is that there are no diseases, only sick people. Diseases in themselves do not have treatment; those who have treatment are the people who suffer from them, and although they tend to be applied in a protocolized manner, there must be variations derived from the personal and biological characteristics of the patient who is going to receive it. This is very important.
The most recent attitude is to do person-centered medicine, not to contemplate the disease in an impersonal way. Similar situations in different people require different therapeutic approaches.
On the other hand, the life circumstances, the way in which the disease has had an impact on his or her life, require us to know the individual particularities that in the end transform a single disease into an indefinite number of different diseases.
From a personal, psychological and spiritual point of view, they ask us to treat them differently. People's lives are always different, and the way we treat them is also different. This attitude leads to the personalization of the therapeutic relationship between the physician and the patient, who thus becomes unique.
Pope Francis speaks of the importance of accompanying not only the patient but also the family. How do you achieve this through palliative care?
- The Pope has said some very motivating things about palliative care for healthcare professionals, such as the decisive role of palliative care, which guarantees not only medical treatment but also human and close accompaniment, because it provides a companionship full of compassion and tenderness. Just holding the patient's hand makes him or her feel the sympathy of the person accompanying him or her, and the gaze can bring a comfort that is otherwise more difficult to achieve.
The Pope also insisted that families cannot be left alone in situations where a loved one is in his or her last days. Too much family suffering is generated in these circumstances. In palliative care, our priority is to attend to the needs of the family, assisting them and accompanying them in their grief.
Some argue that, given the difficult economic situation in some countries, euthanasia is a way to save resources. What is your opinion on this?
- I think there are many false arguments with which public opinion is manipulated. None of the countries that have implemented laws allowing euthanasia are poor countries or countries with scarce health resources. Belgium, Holland, Canada, some states in the USA, etc., are not examples of countries that need to save resources. Palliative treatment of malignant diseases or others that are doomed to death is not burdensome in any case; all that is needed is the decision to organize healthcare for care and relief instead of excessive, sometimes unnecessary, technification, which does make healthcare considerably more expensive.
Some countries are determined to push through laws in favor of euthanasia while doing nothing effective to promote the organization of palliative care. On the other hand, in some countries that have legislated in favor of assisted suicide, and that have facilitated the proliferation of business with it, such as Switzerland, they do not allow euthanasia.
Intentional manipulation is the way in which the law regulating euthanasia has gained a foothold in many countries, including our own. There are words that have been installed as slogans in society, such as dignified death for example, without realizing that to take life is to take away dignity, and that to accompany in illness is to accompany a person similar to us, as worthy as ourselves, towards his or her last destiny.
Does one have to be Catholic to support palliative care?
- Not at all. I would say that caring and accompanying is a universal vocation. Palliative care is a manifestation of humanity in its extreme. I mean that true humanity recognizes the dignity of fellow human beings as possessing an immaterial quality that makes them identical to us until natural death. And so we feel the need to care for and relieve our suffering fellow human beings as we would want them to care for us.
For this it is necessary to recognize that the human being has a transcendence that exceeds the purely material and carnal, and that he is destined for his life to have a meaning. This, which is a manifestation of humanity as a whole, is what Christianity defends, giving man the exaltation that makes him a child of God and an entity that springs from the image and likeness of God.
Therefore, Christians, and more so Catholics, who have the carnality of Christlikeness and earthly life as a path to eternal life associated with us, have all the more reason to develop palliative care as a path of charity and fraternal compassion.
Can we talk about palliative care in a luminous way, without getting carried away by the fear of death and illness? What do you think should be the perspective?
- Of course. In life we always have occasions to reach and feel hope. There are people who perhaps in their lives have not paid attention or have not thought about the end that reaches us all.
In today's world, people don't want to talk about suffering or death, they are removed from conversations and are not paid attention to, they have become a taboo. When the pain is severe, palliative care provides the serenity needed to rethink everything that we have perhaps unknowingly always hoped for.
Early death is only desired by those who suffer in despair of achieving relief, those who are alone or who are not well cared for, those for whom existence has become a burden. But many times I have found that treatment that provides relief from these situations, accompaniment, affection and tenderness makes them change and they regain the hope of living with peace.
Man cannot under any circumstances make himself the master of life. I am sorry for those who defend euthanasia, but there is no noble reason to decide when a life is worth living or when a life no longer has the dignity that keeps it in existence. The recognition of dignity depends precisely on those who care for it.
The end of life can be contemplated with hope. Any circumstance experienced can help us to appreciate that life has meaning, that it is going somewhere. To avoid experiences that can give rise to anxiety, distress, and lead to further spiritual suffering, palliative care is called upon to play an indispensable role in the treatment and care of all people with illnesses that lead to a slow end.
