Alicia Hernando, researcher at ICS of the University of Navarra: “Medicine must take into account all the dimensions of the human being, not only the physical”.

THE QUESTION OF BEING IN PALLIATIVE CARE

Under the title “A literary journey through Cicely Saunders’ Watch With Me”, Alicia Hernando has published an interesting article on the importance of palliative care in a society in need of answers in the last stage of life.

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Alicia Hernando is a specialist in Classical Languages and Spanish Language and Literature and has been a teacher for 11 years. She is currently a Research Staff in Training (PIF) at ATLANTES Global Observatory of Palliative Care, in Intitute of Culture and Society (ICS), at the University of Navarra.

She follows the main plot lines of great authors such as Tolkien, Lewis, Golding or Frankl, in parallel to the human narrative itself, which searches, suffers and wonders. It is precisely on this review that she is currently deepening her research for her doctoral thesis.

This medical field, explains Alicia Hernando, should not only be reduced to a treatment, but, thanks to an interdisciplinary team, involving doctors, nurses and other health professionals, it should also provide a more complete accompaniment, extending to the families, since the patient’s loved ones also suffer with the patient and need other health specialties such as psychology.

In this sense, the British nurse Cicely Saunders is a fundamental pillar on which this mode of care is based, given the valuable learning derived from her work in that hospice for terminally ill patients whom she accompanied until their death: “Cicely tells us that it is necessary to take care to cover a suffering that is total, not just physical pain, but social, spiritual and existential. The medicine that proposes palliative care alleviates other aspects and that is where these important values mentioned in the blog come into play”. He goes on to comment that “sometimes, this implies a deep psychological accompaniment, other times it is just being there, keeping silent and letting the patient open up to resolve the conflicts that go behind and make him suffer in another way. We think of ALS or terminal cancer, but there are other aspects to address, the person also suffers because they feel a burden, or because financially they have to deal with a series of situations, or they believe that there are conflicts that they have not been able to resolve previously…, that is, the end of life is not only medical suffering, but a more complex situation.”

Alicia Hernando argues that the integral vision of man in all his dimensions raises the question of whether the palliative-euthanasia binomial is real: “The debate has become polarized and it is essential to break it, it is played with semantics, with euphemisms: is it a law that helps people to die, is there a real provision of aid? These are terms that permeate society with a purpose that is absorbed in a specific way, although I would not go into this debate so much as into how to make palliative care, which in itself is very good, better known.

The intention with this approach in any case is to alleviate suffering until the last moment. The euthanasia law justifies death by arguing that a point is reached at which no more can be done and that in that critical situation it is justifiable to die, but Alicia Hernando insists that this is misunderstood: “At that critical point the treatment ends with the aim of curing, but not the control of symptoms, you can relieve pain in different ways. Palliative care aims to heal in the deepest sense of the term, not only physically, but from a psychological, existential and spiritual perspective, which is what society has not yet discovered, in fact, I don’t know anyone who knows what palliative care is and does not value it positively after having experienced it,” she confesses.

He gives the example of a doctor who treated a woman with refractory suffering who asked him for euthanasia, but they entered into a dialogue of understanding in which he understood that she was exhausted and could no longer cope, and in response he made a proposal: “well, we have already talked about what we have not, now let’s talk about what we have, what palliative care can do for you”, to which the patient replied: “I’ll give you two days”. In the end, the woman took on a palliative sedation experience that went well and resonated well with the family. In short, she considers that if palliative care were truly known there would be no way of saying no to it: “Of course there are limits, but we must make it known what it is and distinguish it from what comes to us through the media; people do not know what it entails at all because of a manipulation of the language”.

Play Video

David Clark’s lecture on “Cicely Saunders: her life, her work, and her legacy”.

In this line of commitment to the dialogue between science and man, Alicia Hernando finds many reasonable arguments for broadening the academic horizon from the medical schools themselves: “In all curricula there is a need to deepen the subject of palliative medicine, it is essential that the students’ reflections touch on the question of being, that the medical intention to cure in all aspects is propagated, we must continue to insist that advanced medicine can reach all universities”.  

Faced with the paradox that in an operating room a life is being saved while in another room another life may be being taken away, we are presented with a complex panorama: “Our Portuguese neighbors have already passed the euthanasia law and in other countries they are looking at the possibility of opening up these realities beyond refractory suffering. Faced with this panorama, training in palliative care becomes even more relevant, if possible, and the different disciplines contribute to caring for the person in his or her human complexity,” he concludes. 

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