The debate in the media about palliative care in covid-19 and whether it leads to patients being deprived of curative treatment has created uncertainty among colleagues, patients and relatives. In June 2020, the Swedish Association for Palliative Care sent a questionnaire to its members to examine how the debate affected, among other things, the flow of referrals and attitudes towards palliative care. The answers (N = 95) show that 13 percent had a reduced referral flow to palliative care since the debate started and 24 percent feel that patients and relatives received a changed attitude. As many as 28 percent state that they have at least once experienced that medical colleagues have changed their attitude; 20.5 percent have higher this on some occasion and 7.5 percent on several or many occasions. We are concerned about this development.
Here are 5 reasons to continue to offer patients good palliative care:
- Save the patient and loved ones unnecessary suffering.
Palliative care provides good symptom relief when cure can not offer [1, 2]. The debate must not lead to patients needing palliative care, this is withheld. Relatives need support in their grieving process and help to understand the basis of medical assessments. Exposing patients to unreasonable and painful interventions and transfers between care facilities leads to unnecessary suffering without adding value.
- Distinguish between curative and palliative care.
In the event of deterioration, an individual assessment of the individual patient can be made if the cause of the deterioration can be thought to be reversible. This is accompanied by an assessment of which care measures can be beneficial to the patient. In the assessment, the patient’s own wishes weigh heavily . Even for fragile patients with multiple illness, attempts at life-prolonging measures such as antibiotic treatment or diuretic therapy can be meaningful. These measures can also be part of the symptom relief in a palliative phase .
- Continued systematic palliative approach.
Covid-19 has not changed the rules of the game for palliative care. Fragile patients who develop covid-19 may have fulminant processes where life-prolonging interventions are not considered reasonable. We face similar situations in other diagnoses, for example fragile patients with multiple diseases, where in attempts at heart failure or COPD, active attempts are made to reverse the process but are prepared for symptom relief if the measures do not have an effect. In these situations, a proactive approach is used to advantage, where you, together with the patient and relatives, reason about how far the active trials should last and which level of care is judged to be helpful.
- Offering symptom relief is not active euthanasia.
Palliative care must never be associated with active euthanasia, which means that you can carry out medicines that have an active intention to end a person’s life. The purpose of palliative care is neither to hasten nor to delay death. Studies show that god symptom relief can have a positive impact on life expectancy . Therefore, more and more disciplines are working for a systematic integration of palliative care approaches in parallel with life-prolonging treatment. [6-9].
- Symptom relief with morphine and midazolam does not shorten life.
Providing morphine for pain and / or shortness of breath at the end of life is one of the National Board of Health and Welfare’s criteria for good palliative care at the end of life . The treatment is well proven and internationally accepted . The dosage is adjusted individually and evaluated regularly for the desired effect and any side effects. Several studies suggest that morphine is used too sparingly in the final stages of life . Even in this phase, god symptom relief has been shown to prolong life.
Are you unsure? Contact a colleague in a specialized palliative care unit for support and help.