Palliative medicine - what is it?

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Saying goodbye to life is difficult. Palliative medicine aims to make life easier for people with incurable diseases. The focus is not on giving life more days, but rather giving the days more life.

Palliative medicine begins at the latest when the medical possibilities for curing an illness have been exhausted and life expectancy is limited. The most important goal of palliation is to alleviate the symptoms and to achieve the highest possible quality of life for the patient. This also includes, in consultation with the patient, foregoing possibly life-prolonging therapy if this would be accompanied by disproportionate suffering. Thinking palliatively means to basically affirm life and yet accept death as a natural process.

What does “palliative” mean? The term palliative medicine comes from the Latin word “palliare”, which means “to cover with a coat”. He is thus aiming at the protective, caring thought from which palliative medicine arises.

More than terminal care

Palliative medicine is not limited to the last phase of life. Even if a seriously ill person may still live for years, palliative principles can help them to have a better quality of life and as little pain and anxiety as possible from the time the diagnosis is made. In many cases, however, it is also possible to use palliative approaches to accompany a therapy aimed at healing.

Relieve and accompany pain

An essential part of palliative medicine is the best possible alleviation of physical complaints - for example through sophisticated pain therapy and relief from nausea or shortness of breath. In this regard, palliative care has made significant strides in recent years.

Just as important as physical care is psychosocial and often also spiritual support in the context of palliative medicine. Here the carers help the patient to accept the inevitable, to make peace with their own fate and to get the fear of pain and dying under control.

Palliative medicine is always teamwork. Doctors, nursing staff, social workers, psychologists, physiotherapists and pastors work together to provide comprehensive care for the sick. They are often supported by volunteers who are specially trained in terminal care.

Patients' worries about their relatives also have a place in palliative care. For example, how the family gets along without them - psychologically, but maybe also financially. Here, specific offers of help can relieve the patient and his relatives.

Palliative medicine supports patients in living their lives as actively as possible until they die. In a broader sense, palliative medicine also means enabling positive experiences. Just look at the sky. Feel the sun and wind on your skin. Hear a beloved piece of music. Cuddle with the cat. Say goodbye to a loved one.

Relatives in palliative medicine

The relatives are also given palliative support. Ultimately, this also helps the patient - the psychological stability of the relatives and the way they deal with the patient are important for his or her well-being. Palliative medicine supports relatives during the patient's illness, during the dying phase and during the period of mourning. Ideally, one succeeds in accepting dying as a natural process and part of life.

Care in the dying phase

When death becomes foreseeable, it is the task of palliative medicine to enable the patient to die peacefully with dignity. Even in the last phase of life, it is important to control the symptoms and keep the suffering as low as possible.

And of course, palliative care is also about providing emotional support to relatives in the phase of saying goodbye. For them it is important, for example, to be prepared for the changes that can occur in the dying process.

Inpatient palliative medicine

In hospices and in the palliative care departments of the hospitals, people with advanced, life-limiting illnesses receive inpatient care. The aim is to place patients in the hands of carers who are familiar with the current standards of palliative medicine. In some clinics, so-called consultation services have also been set up to provide palliative care for the sick on the respective wards. In many cases it is possible to stabilize the patient to such an extent that they can be treated on an outpatient basis again. If this is not possible, terminal care will also be provided in the clinic.

Outpatient palliative medicine

Most people want to be able to die in familiar surroundings and with loved ones. This is made possible in the context of outpatient palliative medicine. As a rule, resident doctors, outpatient nursing services and volunteer helpers look after the patients. Often this is even possible if the patients require particularly extensive and intensive care. In the so-called specialized outpatient palliative care (SAPV), doctors and nursing services work together in a palliative care team (PCT). They are specially trained in palliative care and coordinate treatment around the clock. In this way, pain and stressful symptoms can be controlled even in more complex cases.

Development of palliative medicine

Palliative medicine is a comparatively young discipline. A "cura palliativa" is reported as early as the 16th century. Around 1800 the term “palliative cure” was used colloquially. In the 19th century, the first hospice-like inpatient facilities were set up in some European cities to look after the dying. The first important representatives of modern palliative care were the psychiatrist Elisabeth Kübler-Ross, who examined the process of dying psychologically, the nurse Cecily Saunders, who founded a dying hospice in London in the 1960s, and Balfour Mount, who operated a palliative medical ward in the 1970s set up in Montreal.

Palliative care in Germany today

Palliative medicine in Germany has been expanded considerably in recent years. However, the supply is not yet comprehensive. On average there are currently (in inpatient hospices and palliative wards) around 40 beds per million inhabitants available in Germany. Experts estimate that at least 50 beds are needed per million inhabitants. International studies even assume a palliative need of 80 to 100 beds. Smaller hospitals in particular often do not yet have palliative care wards.

There are also gaps in outpatient palliative care, particularly in the area of ​​specialized outpatient palliative care. The supply also differs from state to state and is problematic in rural regions.

The draft law to strengthen hospice and palliative care, which was passed by parliament with a large majority at the beginning of November 2015, takes this into account. Both outpatient and inpatient care for the seriously ill and the dying is to be expanded across the board.

For this reason, the last phase of life is still associated with unnecessary suffering for far too many people in Germany. And since people are getting older and the number of cancer cases is increasing, for example, even more beds for palliative medicine will be needed in the future.

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