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BIOETYKA / ETYKA MEDYCZNA - Przeglądy aktów prawnych
Ochrona przed bólem i opieka paliatywna
Prawa o zasięgu światowym
Cancer Pain Relief and Palliative Care – WHO 1990
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Palliative care (s.11)
2.1. Introduction
Palliative care 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. Many aspects of palliative care are also applicable earlier in the course of the illness, in conjunction with anticancer treatment. Palliative care:
- affirms life and regards dying as a normal process;
- neither hastes nor postpones death;
- provides relief form pain and other distressing symptoms;
- 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 patient’s illness and in their own bereavement.
2.6. Organization of palliative care (s. 16/17)
Palliative care centers were among the first to demonstrate the value of regular “round-the-clock” administration of analgesics, notably orally administered morphine. In a few countries demonstration centers have been established but have often had to battle against medical, nursing, pharmaceutical community ignorance, and sometimes antagonism. With the passage of time, the educational impact of these centers is likely to be considerable, studies have already demonstrated that the existence of a palliative care centers results in improved standards of care in neighboring general hospitals.
Fully developed palliative care programmes include the following components:
- Home care. Traditional medical care and funding are based on an institutional model whereas palliative care stresses the hope as the primary setting for care. Institutions are seen as back-up resources rather than as the focal points of the programmes.
- Consultation service. Health care workers who are trained in palliative care provide a consultation service for patients in hospital and in the community. Such a system also provides an educational opportunity for other health care workers.
- Day care. Patients who live alone or who are unable to get out on their own may benefit from attending a palliative care day centre two or three times a week. In addition, day care may do much to alleviate the demands that home care makes on patients’ families.
- Inpatient care. Inpatient care concentrates on controlling pain and other manifestations of of psychical and psychological distress.
- Bereavement support. Some people need extra help to enable them to cope with their bereavement. Support by trained health care workers or volunteers may provide this.
7. Spiritual aspects (s. 50)
Because palliative care is concerned with the well-being of the whole person, it should acknowledge and respect the spiritual aspects of human life.
8. Ethical considerations (s. 52)
The cardinal principles of clinical care are to do good and to minimize harm. In practice, this means seeking an acceptable balance between the advantages or benefits and the disadvantages and burdens of treatment. These principles are applied in conjunction with at least three others:
- respect for life;
- respect for patient autonomy;
- respect in the use of limited resources.
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