Yes.

Ver:

-- Fernández Lópiz, E. (2000): “Los Equipos Asistenciales en las Instituciones: Guía teórico-práctica de técnicas de Análisis Transaccional". Madrid: Narcea. Págs. 230.

ISBN: 84-277-1339-8

While this is a very broad question, I would generally say yes, as it applies to an overall philosophy of care that includes the inevitable process of decline and death as an intergral part of caring for human beings. I have seen this reflected in the oncology world in providers who actively prevented patients from having access to the palliative care team in an inpatient setting do to their own limitations in recognizing that a particular patient has decided that ongoing active treatment is more than they care to endure any longer. If we were to be teaching a philosophy of care that embraces life as a continuum that eventually ends despite our best efforts then I believe providers would be better equiped to transition patients into a phase of palliation. That said I also embrace the concept that palliation is not exclusively an indication of impending death as I believe many providers seem to believe.

From my experience as a doctor for 42 years, including 20 years in palliative care, I would say that on any occasion, palliative care is, if possible, to be carried out in a domestic environment and surrounded by the affection of family members and acquaintances, and only in extreme cases. in the absence of the family and the inability to manage at home (for various reasons) you can opt for Hospice

Absolutamente de acuerdo con el Dr. Mihali. Y añado que los ancianos 'bajo-competentes' son más sensibles y 'agradecidos' a los aspectos gratificantes del entorno, que las personas cuyas capacidades están intactas. Contrariamente a lo que muchas veces se suele pensar.

Interesting idea. There are many philosophies. Not promoting palliative care is also kind of mainstream philosophy. It is broad question. There are many factors. I can see other more influential factors.

The education system has a big influence. At least in my own country. If you as a doctor would have your philosophy but you are taught that to be professional means you must have detachment to your patients, you probably do not share or use your philosophy if it is contradictory to professional setting you were taught.

And also in the discourse of winning medicine, death is very often seen as the failure of a doctor who fails to prolong patient's life. A hope in mainstream discourse is associated with prolonging life rather than focusing on quality of patient's life. The patient is given drugs until the last breath, which could in many cases rather diminish his/her life quality. The physician's help is associated with activity and action, and for many physicians it is inconceivable to imagine that greater value may be to hold patient's hand and talk to him as a human being.

Recommending a hospice care is for most doctors equal to destroying patient's hope. It is like sending him/her to death.

Paradoxically I have heard of a few cases when the patient who came from hospital to the hospice, on the contrary, has improved health.

Another factor is death representations in a given society. If the death is seen only as a destroying entity which we have to fight against until our last breath. Or if the mortality is seen as limits that pushes us to fill life meaningfully.

Well stated Boleslav. I completely concur that the challenge lies in how we train providers, likely in all countries. That said it is a very challenging space to be in as a provider to be both working towards cure or remission and being sensitive to a patients need to back off from all out treatment. As a nurse it is much clearer as our role is taught as supportive both of the treatment and the patient as a holistic entity. The provider must be making decisions that direct the course of treatment and the patient likely cannot fathom the complexity of the choices and often defers to the providers superior knowledge. This responsibility for the provider is monumental when the outcome effects the life of another human!

In my experiences, related in my previous commnet, I never came across a provider who was uncaring and not wanting what they thought was best for the patient. In particular I had experience with a gifted surgeon who was also one of the best at the bedside that I have ever worked with. The deep caring was evident but it included a blind spot which unfortunately interfered with the patient's desire.

The challenge is very nuanced as education is one facet which must honor societal, cultural, and familial influences. In my experience in a society that demonstrates tremendous challenges talking about and embracing the complexities of life, illness, and death it is often in the small moments when the best work is done. Sometimes they are 30 seconds of being present with the discomfort, pain, and sadness of another amidst the ongoing press of what modern healthcare has become. Ultimately we should all be forgiving of ourselves and others and continually be open finding those moments that we can within the context of finding something larger.

La respuesta es que aunque sea formativa y técnica, los cuidados paliativos debe contar con individuos formados en la teoría humanista, bien en Psicología, bien en enfermería, etc. Por eso el cuidador ha de ser en gran medida también vocacional. Ha personas que sencillamente no sirven para eso. Como hay médicos o enfermeros o educadores que no tienen vocación y entonces están abocados al fracaso, aunque sepan mucho de lo suyo.