Category : Correspondence

Palliative care and the active work of the anesthesiologist; a reflection from a bioethical point of view

Templos Esteban Luz Adriana.

General Hospital Dr. Manuel Gea González (Mexico)

Luz Adriana Templos Esteban. Division of Palliative Care and Pain Clinic; Phone: +5240003000 ext 3206, E-mail: luzadrianatemplos@hotmail.com

 Key words: Palliative Care; Pain; Pain management; Anesthesiologist

 Citation: Adriana TEL. Palliative care and the active work of the anesthesiologist; a reflection from a bioethical point of view. Anaesth Pain & Intensive Care 2016;20(4):517

Palliative Care is a comprehensive discipline that is described by the World Health Organization in 1990 as one that is focused on the active and total care of patients with progressive or incurable diseases in whom the management of pain, comfort, and management aspects spiritual, psychological and social.1

In Mexico in December 2014, a document was published in the Official Gazette of the Federation that stated all levels of care in our Health System.2 In the National Development Plan 2013-20183 are mentioned the objectives of the promotion of quality of care in the terminal patient, the promotion of education and the creation of multidisciplinary teams as well as the management of this type of services.

In our country, traditionally it is the anesthesiologists who is responsible for pain management and / or palliative care with training in subspecialty, but we can take some active steps to achieve great benefits as follows:

  1. Communicating bad news. On pre-anesthetic evaluation we may detect anesthetic-surgical risk factors in a palliative patient. We must explain the risks and benefits of the procedures and take advance decisions such as advanced resuscitation, vasopressor management, etc. In many cases not performing surgery may offer greater benefits and allow the patient to spend some more days with his family.
  2. The autonomy of the patient must be respected in decision-making. Sometimes the diagnosis or prognosis of the disease may not be known. As anesthesiologists we have the capacity to inform and support in this regard and to explain properly with an informed consent.
  3. First of all, do no harm. Allow the patient’s beneficence in relation to his illness. Avoid as much as possible unnecessary or futile procedures and if the nature of the surgical act is no longer possible and the patient is in poor conditions, allow the patient to spend his last hours with his family.
  4. Within the principles of palliative care, comfort and pain relief are the first and the foremost priority.4

As a final reflection it is understood that much remains to be done to have an adequate infrastructure in the area of ​​palliative care, but with these simple recommendations we can have a more active and humane role to achieve a better quality and warmth in the care of these patients and their families in a terminal situation.

REFERENCES

  1. World Health Organization. Palliative Care. Available at http://www.who.int/cancer/palliative/es/ .
  2. Official Mexican NOM-011-SSA3-2014, Criteria for care of terminally ill patients through palliative care. Available at http://www.dof.gob.mx/nota_detalle.php?codigo=5375019&fecha=09/12/2014.DOF 09/12/2014.
  3. National Plan of Development in Palliative Care. Available at http://calidad.salud.gob.mx/site/mail/2015/01/doc/02_E.pdf.
  4. “Care When There Is No Cure: Ensuring the Right to Palliative Care in Mexico,” Human Right Watch. October 28, 2014 Available at http://features.hrw.org/features/HRW_2014_report/Mexico_Care_When_There_Is_No_Cure/index.html