The 11th EAPC Congress
Faced with death, what are the wishes of terminally ill patients? Does a request for euthanasia disappear with good palliative care? How invasive should medicine be at this final stage of life? Is comprehensive palliative care financially affordable? Can studies on those who are dying be ethically justified? Difficult questions, but all posed during the 11th European Association of Palliative Care (EAPC) Congress. Held in May, the event drew 2,500 international participants. H C Pruszinsky reports
Confusion over ‘terminal’ or palliative sedation with euthanasia is typical. They are two completely different concepts. ‘Palliative sedation aims to ease intolerable levels of suffering through the help of highly sedative medication, but there is no intent to end patients’ lives,’ he explained.
Some patients are scared of the capabilities of modern medicine and worry that their lives may be unnecessarily prolonged, or that they may end up suffering intolerably, and so the possibility of euthanasia or medically assisted suicide may appear to be a way out. ‘The Ethic Task Force of the EAPC therefore advocates a direct and open dialogue with the supporters of euthanasia and medically assisted suicide,’ he pointed out.
EU funding secured
Palliative research is catching up remarkably on a European level, due to a range of activities. One important contribution was made by the EAPC Research Network. With the European Palliative Care Research Collaborative (EPCRC), the first, large-scale palliative research project has begun. ‘There are 11 centres in Great Britain, Italy, Switzerland, Germany, Austria and Norway, and the project is co-ordinated by the Norwegian University for Science and Technology in Trondheim, and we have secured EU funding of 2.8 million euros over a three-year period,’ Prof Kaasa said.
The main topics of this project are to identify genes and genetic changes that are responsible for very different reactions in individual patients to opioid treatments, as well as genetic changes that increase the risk of cachexia. The term covers a number of symptoms characterised by significant debility that frequently occurs in palliative patients.
Another aim is to improve pain measurement, with computer assistance.
Based on such standardised classification, the development of evidence-based guidelines for the capture and treatment of pain, depression and cachexia is envisaged.
The fourth aim will be to ensure co-operation beyond the period of EU funding, by developing lasting oncological palliative research co-operation across Europe.
Loss of dignity: the biggest impact on the terminally ill
General debility and loss of dignity are the main reasons why terminally ill patients would like all life-preserving procedures stopped, according to a Dutch study presented at the congress. Swiss experts said not enough is known about the motives for the desire to carry out assisted suicide. A study is set to deliver palliative care tips for better strategies against acts of desperation and capitulation.
In Switzerland around 200 – 250 people annually contact organisations that ‘arrange’ assisted suicide which, with under certain conditions, is legal there. However, according to care expert Alexandra Bernhart-Just of the Centre for Care Research at Zurich University Hospital, the motives for such decisions made by patients have still not been sufficiently researched. For planning optimum palliative care this is a real problem: they are the very people at whom specialised care is aimed, so that such acts of desperation and capitulation do not arise.
‘From a medical point of view the question of euthanasia is often a – sometimes desperate – call for help,’ pointed out congress president Professor Hans-Georg Kress (AKH Vienna, Medical University Vienna). ‘Critically ill patients are often trying to tell us in this way that they are suffering because of their physical symptoms, the loss of independence or that they can no longer cope with the illness-related life changes. Comprehensive palliative medical care through an experienced, multi-professional team can alleviate many of these problems and redress the need for euthanasia.’ For others, who subjectively experience serious suffering, the offer of palliative sedation, i.e. a reduction in their degree of alertness and level of consciousness right down to permanent sleeping through the repeated administration of sedating medication may be an acceptable solution.
www.european-hospital.com presents an extended online EAPC report
Product of the month
Versatile connectivity and ease-of-use provide a range of benefits ...
Carestream has implemented companion views in its digital ...
Radiologie Herrsching setzt auf die Nadel-Leuchtstoff-Technologie ...