Centeno C

Martin-Moreno JM

Ourania Varsou

Rocafort J

Journal of Palliative Medicine

English

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Dying with Dignity: Is This a Universal Concept?

Varsou, Ourania

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Dying with dignity: Is this a universal concept?

The Open University

Personal ReflectionDying with Dignity: Is This a Universal Concept?Ourania Varsou, MBChBAs a doctor, I had many times to break bad news toterminally ill patients and their families in terms of thediagnosis, prognosis, and palliative care options. However, Iwas never a relative myself in such a situation. I had dealtwith bereavement in the past following the death of my fa-ther, but this was a sudden and unexpected event. In the caseof my mother, the circumstances were very different and forthe first time I found myself struggling with the fragility ofthe human body and the uncertainty that exists when caringfor a terminally ill cancer relative. However, what surprisedme in my home country was the lack of organized interdis-ciplinary palliative care in state-funded hospitals,1,2 the re-stricted range of opioid medications available for paincontrol,1,2 and even the acceptance of death as the naturalcourse of severe illness.2It seems that in Greek urban places, death and the dyingprocess has become a taboo subject that is best to be avoided.2Disclosing the truth about the diagnosis and prognosis, espe-cially to terminally ill patients, is a topic that relatives tend toavoid and the health care professionals do not object to thefamily’s wishes out of respect. In the presence of the patient,carers tend to focus away from the negative impact of thedisease, the possible consequences, and the prospect of death;instead they try to adopt a more positive attitude. This avoidantbehaviour may have cultural roots, but with limited scientificresearch published on this area, it is extremely difficult toprovide a plausible explanation or even a justification.Palliative care also seems to be an unfamiliar concept inGreece and in my opinion not well understood among rela-tives and even health care professionals. Although palliativecare was recognized in Greek law, in 2005, there are still verylimited governmental palliative care and bereavement ser-vices.1 It is very surprising that there are no officially es-tablished inpatient palliative medicine units in state-fundedhospitals, no governmental hospices for adults or children,and there are only a small number of home care teamsavailable. Overall, support is provided mainly by charitiesand volunteers.1,2 When compared to the rest of the EuropeanUnion, Greece is among the least developed countries interms of palliative care services.3 This general lack of gov-ernmental support for both patients and carers makes theprocess of dying even more difficult in terms of physical andpsychological coping.While I was writing this article, I was very pleased to findout that the availability of palliative medicine services inGreece is improving. There is a Pain Relief and PalliativeCare Centre in Aretaieion Hospital of Athens that providescare to outpatients and a small number of inpatients. Al-though this is the only specialist unit in Greece that is stillevolving, it is encouraging to see that steps are being takentowards improving accessibility to palliative and end-of-lifemedicine.4 Recently, the country also joined the Access toOpioid Medication in Europe (ATOME) project that aims toidentify legal/regulatory barriers and therefore make ap-propriate recommendations for improvement.5 In addition,the Hellenic Association for Pain Control and PalliativeCare and the Hellenic Society of Palliative and Sympto-matic Care for Cancer and non-Cancer Patients are con-tinuing to increase awareness in Greece and their efforts areto be commended.1In the case of my mother, we were very privileged as afamily to be able to afford inpatient private medical care withcomprehensive ongoing symptom control, and during thecourse of her illness up until the last days before her death shewas very comfortable. However, I do wonder from time totime what happens to the many other patients and relativesthat are faced with a similar situation in a country wherepalliative care is a new or even alien concept altogether andtherefore it might not be readily available apart from privatemedical providers. Do these people attend for their lovedones on their own unsupported at home? Do they struggle instate-funded hospitals? I am not sure how these families cope,but for me this was an eye-opening experience in terms ofappreciating the importance of palliative care services.Dying with dignity is a fundamental human right thatshould not be denied or withheld. Hopefully in the futuremore countries will embrace and actively support the deliv-ery of organized interdisciplinary palliative care within spe-cialist units.References1. Centeno C, Clark D, Lynch T, Rocafort J, Flores LA,Greenwood A, et al.: EAPC Atlas of Palliative Care inEurope. Milan: European Association for Palliative Care,National Cancer Institute, 2007.2. Rocafort J, Centeno C: EAPC Review of Palliative Care inEurope. Milan: European Association for Palliative Care,National Cancer Institute, 2008.3. Martin-Moreno JM, Harris M, Gorgojo L, Clark D, NormandC, Kennedy E: Palliative Care in the European Union.School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.JOURNAL OF PALLIATIVE MEDICINEVolume 17, Number 4, 2014ª Mary Ann Liebert, Inc.DOI: 10.1089/jpm.2013.03401Brussels: European Parliament Committee on the Environ-ment, Public Health and Food Safety, 2008.4. Greece: Pain Relief and Palliative Care Centre AretaieionHospital. Pain Relief and Palliative Care Center. Athens,Greece, 2014. www.palliative.gr/uoa/english/history.html. (Lastaccessed June 8, 2013.)5. Vranken M, Mantel-Teeuwisse A, Schutjens MH: Scan ofnational legislation: Results of the ‘‘quick’’ scan of nationallegislation of twelve European countries (work package 7).Utrecht: Utrecht University: Access to Opioid Medication inEurope (ATOME), 2013.Address correspondence to:Ourania Varsou, MBChBSchool of Medicine and DentistryUniversity of AberdeenPolwarth BuildingForesterhillAberdeen, AB25 2ZD, United KingdomE-mail: o.varsou@abdn.ac.uk2 PERSONAL REFLECTION

Access to Opioid Medication in Europe (ATOME),

C: EAPC Review of Palliative Care in Europe. Milan: European Association for Palliative Care, National Cancer Institute,

et al.: EAPC Atlas of Palliative Care in Europe. Milan: European Association for Palliative Care, National Cancer Institute,

Pain Relief and Palliative Care Centre Aretaieion Hospital. Pain Relief and Palliative Care Center.

Dying with Dignity : Is This a Universal Concept?

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Dying with Dignity : Is This a Universal Concept?

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