Palliative care is there when the battle against an illness is lost
The topic of euthanasia and assisted suicide is discussed again and again in society. Many people are driven by the desire to end their lives in the event of a serious illness. Reasons for this include fear of pain and of being alone, the fear of no longer being able to live a self-determined life, or the wish not to be a burden on their fellow human beings. Wishes that are taken seriously - even if it has been expressly forbidden by law since 2016 to provide assisted suicide commercially or in an organised form.
One of the great ethical questions ...
One of the big ethical questions is whether and to what extent euthanasia can be humane at all. How does palliative medicine deal with this question, which wants to enable people consecrated to death to die as humanely as possible? On the occasion of the discussion on euthanasia and assisted suicide in 2014/2015, the German Hospice and Palliative Association (Deutscher Hospiz- und Palliativ-Verband e. V., DHPV) had prepared a position paper in which it expressly welcomed the discussion on a ban on all forms of commercial and organised assisted suicide. The core statement: Under no circumstances should there be political and legally opened options that legitimise these forms of assisted suicide and advertising for it.
There are solid reasons for this. In the opinion of the DHPV, the normalisation of assisted suicide would increase the pressure on sick and elderly people not to want to be a burden on others, which cannot be wanted in a society based on solidarity, according to a DHPV statement of 22 September 2015. But what distinguishes the work of hospices and palliative care facilities as well as palliative services from assisted suicide?
Isn't palliative care also a kind of assisted suicide? A clear no.
Unlike other sick people, the focus for the seriously ill is no longer on healing and prolonging life, but on maintaining the best possible quality of life, pain relief and alleviation of other symptoms, as well as closeness and care. According to the WHO definition of 2002, palliative care is "an approach to improving the quality of life of patients and their families facing a life-threatening illness. This is done by preventing and alleviating suffering through early recognition and proper assessment of the treatment of pain and other discomfort of a physical, psychological and spiritual nature". As can be seen, assisted suicide would be something quite different, since here the dying process is accompanied and cushioned, but no medication is used to accelerate this process or to deliberately bring about death.
What is palliative care?
The word pallium (Latin) means cloak. In a symbolic sense, palliative care aims to envelop patients and protect them from pain and unbearable suffering. It was originally developed for tumour patients, but in the meantime the field of palliative medicine has expanded to include AIDS, various organ diseases and neurological diseases. The aim is to maintain the quality of life as best as possible until the end of life and - and this is the big difference to medicine for curable diseases - to allow dying. Dying is understood as a part of life. This support is oriented towards the wishes and needs of the seriously ill and dying people and their relatives. In addition to medical aspects, spiritual and psychosocial suffering are also taken into account. Palliative physicians work in a team with many other specialists such as nursing staff and doctors, but also with social workers, psychologists, pastoral care workers, psychotherapists and physiotherapists.
Often, seriously ill and dying people want to be able to stay at home in familiar surroundings until the end of their lives: one of the essential tasks of outpatient hospice services. Therefore, the principle of outpatient before inpatient applies in palliative care. However, there are also palliative care units in hospitals: they are an independent specialised facility integrated into the hospital for the care of seriously ill and dying people who require hospital treatment.
The first palliative care unit was established at Cologne University Hospital in 1983
Palliative medicine has its origins in the University Hospital in Cologne. The first palliative care unit in Germany was established there in 1983. Today there are more than 250 palliative care units nationwide, with very different distributions in the federal states. The German Hospice and Palliative Association (Deutscher Hospiz- und Palliativverband e. V.) estimates the need for a total of 50 beds per million inhabitants; internationally, it is assumed that there is a need for 80 to 100 beds per million inhabitants. The latest state of development is published in the Hospice and Palliative Medicine Guide.
DHPV: In the end, it's the person who counts
The DHPV (mission statement: In the end, it is the person who counts) is the umbrella organisation of more than 1,200 hospice associations and palliative care facilities, in which more than 120,000 people are involved on a voluntary, civic and full-time basis. According to the DHPV, people in their last phase of life are particularly close to its heart.
