Palliative care is basic care

Marinela Olăroiu, MD, PhD, Editor-in-Chief of PALIAŢIA

International organizations repeatedly emphasize the importance of palliative care as being an integrated part of regular health care, i.e. basic care. Recently, the Romanian Ministry of Health has published an important document, which presents the organisation for palliative care, as reported in this issue of PALIATIA. Indeed, if palliative care is basic care, this document will be a big step forwards for the further development of palliative care in Romania.

What means ‘basic’? Basic may refer to the way things are organised or processed, i.e. a logical way of organisation. Basic may also refer to what human beings need. Basic needs for human beings are food, water, cloths, and shelter. But basic needs also include accessible education and health care. In the case of care, dignity and respect are basics, which means that all people, working in health care (professionals, staff members, and policymakers), treat patients with dignity and respect at all times. This concerns not only persons, but also applies to organisations.

Dignity includes listening to the concerns of the patient, expressing these concerns are important, communicating in such way that the patient understands, and participating in the conversation and decision-making. For example, never talk about the patient as though he is not there, when you are with the patient.

Respect means to recognize the autonomy of the patient and starts with privacy, physically and psychologically. Based on this autonomy it includes the right of the patient to make his own choice. If a patient’s choice may be harmful, explaining and discussing options is the way to guarantee his autonomy, even if it seems ‘nonsense’ from a ‘professional’ viewpoint.

Both dignity and respect cover all aspects of daily life and include interpersonal behaviour and relation between client and caregiver as well as the way health care is organized. The way (palliative) care is organized and structured is still a major concern worldwide. If the organization and structure do not guarantee dignity and respect how should basic care be realized? If these basics are legally ensured and monitored, palliative care will become an integral part of health care.