ETHICS OF PALLIATIVE CARE IN ROMANIA FROM PRINCIPLES TO PRACTICE
ETHICS OF PALLIATIVE CARE IN ROMANIA FROM PRINCIPLES TO PRACTICE

Summary/Abstract: Background: According to the World Health Organization, „palliative care is an approach that improves the quality of life of patients and their families, in the face of the problems associated with life-threatening illness, through the prevention and elimination of suffering, through early identification, proper assessment and treatment of pain and other physical, psychosocial and spiritual problems”. WHO considers that palliative care: ensures the removal/reduction of pain and other symptoms; promotes life and approaches death as a natural thing, which it does not withhold or quickens up; integrates the psycho-social with the spiritual aspects of care for the patient; provides a support system to help the patient to live a life as close to normal until death; and offers a support system to help the family cope during the patient's illness situation and after his death. In order to address all the needs of the patient and his family, palliative care is based on a team approach. Palliative care can improve quality of life and can influence positively the progress of disease. This approach can be applied early in the course of illness, possibly in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, including the investigations needed to understand and manage clinical complications. Objective: Highlighting how the fundamental principles of bioethics can be found in the practice of palliative care in the context of the current socioeconomic context in Romania. Method: Enrolling in the holistic ethic trend, this paper examines the four principles of bioethics used in current clinical practice through a scenario of case studies selected from an extensive qualitative research that aimed to identify factors affecting the dignity of terminally ill patients. Research Results: The analysis revealed the ambiguous way in which medical decisions are made in relation to the fundamental principles of bioethics, the ineffective management of the physical, psychological, social and spiritual needs, in the context of personal values, cultural, religious beliefs of patients and their families, the effects of communication difficulties, ineffective or insufficient professionalism of care staff, deficient legislation, and the lack of visibility of the commissions of clinical ethics activity. Conclusions: Socio-economic context and legislative framework, the level of development and professionalization of this medical field are making a considerably footprint on the application and observance of ethical principles in the practice of palliative care and, consequently, respect for the rights of terminally ill patients.

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