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Antea Worldwide Palliative Care Conference

Rome, 12-14 November 2008


Orsi Luciano
Email: The classic words of 1989 WHO definition of Palliative Care (PC): “PC affirms life and regards
dying as a normal process, neither hastens nor postpones death” are still valid or need to be
Phone reframed? In current medicine “natural” death doesn’t exist, but probably “natural” death
disappeared form the first borning of medicine, which in itself modified the process of dying.
Nowdays medicine (oncology, intensive care, etc.) interfere heavily with dying process and death is
Mobile phone a consequence of multiple, progressive decisions. Two key passage in the flowchart of modern
dying are decisions about forgoing therapies (chemiotherapy, radiotherapy, surgery, life-sustaining
treatments, etc.) and beginning of PC assistance. The moment, the setting and the way of the dying
process are highly dependent from these decisions, usually taken months, weeks, days or even
Please underline the most
appropriate category for your
minutes before the death moment. These decisions are inevitably taken by almost all health care
abstract professionals in almost all fields of medicine, some time with full awareness of consequences, some
time not. What is often misunderstand is that these choices are more ethic than technical. Indeed,
• Pain and other symptoms in forgoing and in PC the prevalent aspect of decisions is not which therapy withhold or withdraw
• Palliative care for cancer patients but when, why, and how implement these choices. A realistic and deep analysis of these decisions
reveals that anthropological and moral point of view of patient, families, and health care
• Palliative care for non cancer professionals are the main factors in the decision-making process about forgoing therapies and
patients starting with PC. In the post-modern medicine and societies patient’s autonomy is the leading
• Paediatric palliative care factor in end-of-life decision-making process. The more original and distinguishing aspect of PC
• Palliative care for the elderly movement is the patient-centered care. Putting the patient’s autonomy in the middle of this
• The actors of palliative care “philosophy” means supporting the patient in decision-making process and respecting her/his
• Latest on drugs choices. In medicine, as in other parts of society, the ancient moral principle of beneficience is
inevitably overruled by the modern principle of autonomy. End-of-life matters (when, why, how
• Pain forgo therapies and start/increase with PC) are anthropologic and moral matters and it’s difficult
avoid the patient’s will and rights. It will become more and more difficult for medicine to ignore or
• Illness and suffering through
undermine patient’s autonomy. PC can’t ignore that “affirming life and regarding dying as a
media normal process, neither hastening nor postponing death” is not a anxiolitic mantra or a granite
• Marginalisation and social stigma stone. Medicine is increasingly invasive, individuals rights are evolving towards autonomy in end-
at the end of life of-life and the moment, the place, the way of dying are more and more matters of patient’s choice.
• Palliative care advocacy projects This is the storming “sea in between” in which PC must sail: maybe the sailing will be easier and
moral if we will stay nearer the patient and we will respect her/his will in the end of her/his life.
• Prognosis and diagnosis
communication in
different cultures
• Communication between doctor-
patient and patient-
• Religions and cultures versus
suffering, death and
• Public institution in the world: palliative care policies and law

• Palliative care: from villages to
Session: Euthanasia & Futility
• Space, light and gardens for the
terminally ill patient Chair of the session: Dott. Franco Toscani
• End-of-life ethics
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support
• Volunteering in palliative care
• Rehabilitation in palliative care
• Euthanasia & Futility