Occasionally, in my medical practice, I meet patients who suffer from incurable diseases, but who need to be treated to maintain an adequate disease or to improve their quality of life, that is, to provide palliative care. The World Health Organization defines palliative care as “active and total patient care that does not respond to curative treatment, with special attention to pain, control of physical, psychological and spiritual symptoms, including family and care for a team. multidisciplinary ”.
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In 2002, the WHO specified that “everyone with a progressive and advanced disease has the right to receive palliative care”. The current epidemiological context is characterized by an aging population and an increase in chronic degenerative diseases whose progress, in most cases, to advanced and terminal stages, makes it necessary to know and apply this type of care, always involving the family.
The antecedents of the current concept of palliative care are found in the first efforts to combat pain, mainly on the subject of cancer.
In Mexico, palliative care has emerged as a movement to control pain in cancer patients, based on the increase in these diseases and according to epidemiological reports. Since 1996, work has begun to establish the official Mexican Standard for the practice of analgesics and palliative care.
In 2006, a consensus was reached on the management of pain caused by cancer and, based on these studies, pain clinics were developed in various institutions in the country, which favored the training of many algologists as palliative care.
Later, the legislature began to discuss legal changes in opioid pain management and palliative care, as drug trafficking has always been a headache in our country.
In December 2009 it was published in Official Journal of the Federation, the decree establishing the reforms to the General Health Law; The modified articles were: 166 Bis (terminally ill); The third cut. II and XXVII bis (medical care and comprehensive pain treatment); 33 frac. IV (palliative care activities, by a multidisciplinary professional team).
The fact that the most discussed topics in Mexico are the attitudes and beliefs of health professionals and the conceptual review of the subject reveals at least two dimensions to reflect on: the first is the uncertainty that many doctors work with in terms of conceptualizing and applying palliative care. An example in this sense is the lack of consensus in key terms such as: terminal illness, terminality, palliative sedation, among others.
In addition to the lack of clear criteria for the application and interpretation of regulations and administration, generating in some cases defensive attitudes on the part of doctors, patients and relatives.
And the second is that another topic of great relevance that deserves in-depth analysis is the concept and application of palliative care, which breaks with some of the foundations and practices on which modern medicine is based, especially the healing paradigm and model. . paternalism in the doctor-patient relationship that could be related to the institutional structuring of services and the reluctance of some doctors to apply these measures in a timely and appropriate manner.
The limited approach of the subject in medical schools, because, in the curriculum, the management of opioids is touched tangentially and remains of specialties such as anesthesiology.
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This school deficiency has favored general practitioners and many specialists not to use them even when it is indicated. However, palliative care is so important in medical practice that we cannot let it go unnoticed.