Page 59 Guide to Pain Management in Low-Resource Settings

Chapter 8

Principles of Palliative Care

Lukas Radbruch and Julia Downing

What is palliative care? What are the principles
of palliative care?
Palliative care is an approach that improves the quality
of life of patients and their families facing the problems Palliative care is a philosophy of care that is applicable
associated with life-threatening illness, through the pre- from diagnosis (or beforehand as appropriate) until
vention and relief of suff ering by means of early identifi - death and then into bereavement care for the family.
cation and impeccable assessment and treatment of pain Often palliative care is seen as focusing on end-of-life
and other problems, physical, psychosocial, and spiritual. care only, and while this is an important aspect of pallia-
Th is widely accepted defi nition of the World Health Or- tive care, it is only one component of the continuum of
ganization from 2002 includes some changes compared care that should be provided. It is focused on the needs
to an older WHO defi nition from 1990. Th e defi nition of the patient, their families and carers. It is the provi-
explains and reinforces the holistic approach, which not sion of comprehensive holistic care with the patient at
only covers the physical symptoms, but extends to other the center of that care, and is dependent on attitudes,
dimensions and aims of care for patients as they suff ers expertise, and understanding. It is a philosophy that can
now with their disease, with their own personal story, be applied anywhere—across a range of skills, settings,
and in their actual setting and social context. and diseases. Th e WHO has outlined several principles
Th e WHO provides a similar defi nition for pal- that underpin the provision of palliative care, including
liative care for children—the active total care of the child’s statements that palliative care:
body, mind, and spirit—and also involves giving support • Provides relief from pain and other distressing
to the family. It begins when illness is diagnosed, and symptoms;
continues regardless of whether or not a child receives • Affi rms life and regards dying as a normal process;
treatment directed at the disease. Health providers must • Intends neither to hasten nor postpone death;
evaluate and alleviate a child’s physical, psychological, and • Integrates the psychological and spiritual aspects
social distress. Eff ective children’s palliative care requires of patient care;
a broad multidisciplinary approach that includes the fam- • Off ers a support system to help patients live as
ily and makes use of available community resources; it can actively as possible until death;
be successfully implemented even if resources are limited. • Offers a support system to help the family
It can be provided in tertiary care facilities, in community cope during the patient’s illness and in their
health centers, and wherever children call home. own bereavement;
Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 47
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.