When it is not possible to cure, it is possible to care. In this article I propose some reflection on how to do it. We should start by taking into account that if the only thing that interests us is the disease, forgetting who suffers from it, we will lack something to do it completely well. The person’s needs in relation to his health go beyond the simple model of curing the disease. The understanding of the patient in his way of react to illness and suffering requires from the doctor an attitude focused on serving the person. If we are not able to express any emotion in our behavior with the patient but only show our technical skills, we may not be able to offer what the person suffering from an incurable, advanced and terminal illness needs most, which is our human approach, our accompaniment.
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“The needs of the person in relation to their health go beyond the simple model of curing the disease” |
Perhaps the word accompaniment is new to the doctor and, in many cases, is outside the provisions of the health administrations. But we must not forget that we doctors must commit ourselves to the life of the patient, get actively involved and offer comprehensive and individualized care in all phases of the disease to solve all kinds of needs. We must provide supportive care from the very moment of diagnosis and quality palliative care in the advanced stages and in the final stage of life. We must accompany him so that the process of dying is dignified, helping him to achieve a peaceful and serene death, without any suffering. We must provide comprehensive care throughout the entire trajectory of his illness and under the commitment not to abandon him when the treatments stop having their curative effects. The patient has understood that the technique is no longer useful to him to cure his illness, but he needs people, his family, his friends, his professionals, his doctor. He already knows that we are not gods, but he needs us to accompany him when he needs it most, in the final stage of his life. He needs the doctors to accompany him to alleviate his suffering until his death arrives.
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“Relieving and treating the symptoms that cause suffering is not an optional matter for the doctor but an obligation” |
How can we and should we do it? Respecting the will of the patient and his values through continuous dialogue with the patient or through the advance directive document when he cannot personally express his will. Not abandoning you through insufficient treatments. Considering that alleviating and treating the symptoms that cause suffering is not an optional matter for the doctor but an obligation. Adapting the diagnostic and therapeutic effort to avoid the unnecessary prolongation of the agony. And sedating when presenting refractory symptoms, taking into account that the purpose sought with sedation is the measure to assess the act as ethical.
It is essential that physicians recognize the practical and ethical limits of our power so as not to exceed them in order to avoid useless and harmful treatments for the patient. The terminally ill it needs less technical treatment and more human care. Let us be aware that we can continue accompanying the patient with our care, even if it is no longer possible to cure him.
