Experts demand a dignified end of life in hospitals

The president of the SEDISA Advisory Council, the Spanish Society of Health Directors (@SEDISA_NET), Mariano Guerrerohas advocated the implementation of clear procedures integrated into the quality programs of healthcare organizations to guarantee a dignified end of life in the hospital setting.

“It is essential guarantee the emotional support of the patient, his family and the healthcare team itselfeven in shared rooms. My concern, as a doctor and as a manager, is that these situations continue to depend excessively on the individual sensitivity of the professional and not on clear procedures integrated into the quality programs of health organizations,” said Guerrero.

In this context, he has made a call to health managers: “It is not enough to agree on what should be done, it is necessary for institutions to regulate it, order it and make it possible“

This was shown during a meeting on-line held by the Advisory Council of the Spanish Society of Health Directors (SEDISA), dedicated on this occasion to How to ensure a good death for hospitalized patientsa process that, as experts agree, must be approached with deep respect, planning, humanity and with clear procedures to reduce suffering and ensure the dignity of patients.

“Talk about how ensure a good death for the hospitalized patient It is not just a clinical or ethical debate, but an unavoidable challenge for healthcare organizations and those who direct them. Health managers must reflect on what is done, what is not done and what should be done to guarantee that the end of life in the hospital occurs with dignity, respect for the patient’s values ​​and the greatest possible well-being,” Guerrero said.

The speakers at the meeting have defended that hospitals must have “clear, realistic and humanizing” protocols for end-of-life moments. “If we are capable of protocolizing very complex processes, how can we not protocolize a basic procedure to accompany a dying patient with dignity?” Guerrero added.

For this reason, experts have called communication standards of bad news, support and end of life protocolsrooms or spaces that guarantee privacy, coordination between services To avoid contradictory decisions, training and emotional awareness for staff.

The difficulty of dying in a shared environment

In this framework, the professor of Legal Medicine and specialist in Ethics, Rafael Pachecohas offered an introductory reflection on the human, cultural and symbolic dimension of the end of life, remembering that Death is not only a biological factbut also a structural element of our human condition: “The fact of death humanized us all. “We are human from the moment our brain was able to create enough abstraction capacity to know that we are going to die.”

Regarding the hospital context, he stressed the emotional and organizational difficulty of dying in a shared environment: “When a patient dies, even the noise of the plant stops. And there is almost a kidnapping of the corpse, as if it had to be hidden. This reflects the extent to which the taboo of death passes through us“.

“There is no such thing as a good thing to die: there is such a thing as doing things well, badly or fairly”

For its part, Juan José Rodríguezmember of the Ethics and Deontology Commission of the Collegiate Medical Organization, has offered an intervention on the role of professionals in the patient’s final moments: “I do not believe that there is good death nor the good to die. Dying will never be good. What we can do is do things well, badly or regularly.“.

Rodríguez has insisted that suffering is divided into physical and moraland The latter is the one that most needs organizational changes. And it has reinforced the central role of autonomy in these issues: “The only way to defend our own professional dignity is respect the dignity of the patient until the end. “We cannot allow the doctor’s convictions to dominate the patient’s decisions.”

Likewise, he has defended a more generous and consistent application of palliative sedationhighlighting real cases in which it is withdrawn based on subjective criteria of different professionals, which he described as “medical malpractice“.