Should palliative care be a self-standing medical specialty?

Professor dr. Daniela Moșoiu, Chairman of PALIAŢIA

The palliative care movement has gained momentum in recent decades. Its inclusion as an integral part of existing health systems requires adequate training of clinical staff, access to medication and legislation to enable the development of these services in both community and hospital settings, all under the umbrella of a coherent national strategy.

The training of doctors and the minimum requirements to confirm them as specialists able to work in palliative care varies across Europe and the world.  In some countries a specialised training is needed; other countries require a sub-speciality training and at the extreme end in some place’s days or weeks of continuing medical education courses is sufficient. Such a diversity will automatically have impact on the quality of care offered to the patients.

Stipulations of international documents support a more specialised training of doctors such as the World Health Organisation Resolution 67 on palliative care, which in paragraph 1.4 (c) “calls on Member States (…) to make available specialisation in palliative care to train health professionals (doctors and nurses) who will manage the integrated care of patients with complex symptomatic conditions” (

The specialty of Palliative Medicine is already regulated in six countries in Europe (UK, Ireland, Slovakia, Poland, Malta, and Denmark) and other countries such as Romania are in the transition phase from subspecialty status to the specialty of Palliative Medicine.

In Romania, the need to transform the present sub-specialty into a specialty seems to be more and more acute due to the need to solve administrative and organizational issues (for example, outpatient clinics can only be established in the physician’s specialty). Another reason is to meet the real and increasing demands of clinical practice in multiple medical specialties to provide highly qualified care for patients with progressive chronic diseases, by complementing and providing the necessary support simultaneously with therapeutic procedures and curative treatment, in order to increase the quality of life of patients.

However, there are also concerns that the transformation of palliative care into a specialty will be a barrier to the dissemination of the concept in other specialties and that young physicians must too quickly decide to join a specialty with a strong emotional impact without having had the opportunity to work in another field of curative medicine.

There is no simple answer to the question in the title and a national consultation needs to precede the decision of moving palliative care towards a specialty with serious thought given to the administrative issues and capability of different stakeholders to run such programs in the country. I am keen to hear your opinions on the topic.