Source: Cadena Ser
By: Elena Morales
Source: Cadena Ser
By: Elena Morales
The health crisis caused by the COVID-19 has strained the structures of our National Health System in all phases of the medical care, including death. The acknowledgement of the health professionals’ performance within the framework of this pandemic is unanimous, and neighborly initiatives and collective responsibility reveal the capacity of citizens to respond to an emergency with solidarity and creativity. However, there are some considerations regarding the management of the last phase of life, which we should also face based on those same values. The traumatic fact that the virus is shortening thousands of lives, sometimes unexpectedly, does not excuse the need to approach the situation with the responsibility that can be expected from a mature society. The end of a dignified life is a dignified death, and we must try to preserve such principle even in these convoluted circumstances.
Although citizenry has accepted the temporary suspension of some rights during the state of alert, of which freedom of movement would be the maximum example, we are conscious that a responsible State must minimize, as much as possible, the regression in this matter. For this reason, we deem appropriate to remember that the ability to decide on one’s life and the family accompaniment are part of the patients’ rights and should be guaranteed as far as possible. Citizens must keep in mind their rights so that they assess their different options and thus request the application of those they consider appropriate, with the assistance of professionals to make them possible, and that of the institutions to guarantee the previously mentioned rights of patients.
The decision to give up a certain treatment seems easier when there is a clear diagnosis of suffering a terminal process deteriorating our health so severely that it prevents us from being mentally independent. In the case of Covid-19, as it is not necessarily irreversible, decisions at the end of life are much more complex. However, it should be noted that an informed consent is the foundation of the healthcare relationship and, therefore, that also in this difficult situation it is necessary to make an effort to respect the patients’ right to be informed, to choose between the different clinical options, to be relieved from suffering and to have a dignified death in the company of their loved ones. Before making any decision, it is very important, and a legal imperative, to ask each person about their values and their will, which should be respected as much as possible.
We must also be prone to guarantee the accompaniment of at least one family member or trusted person—with the appropriate protection measures—in those cases where the disease becomes irreversible. In this sense, we welcome both the proposals by professional associations such as SEMFYC or SECPAL, and the implementation of protocols from the institutions, and we urge the Autonomous Communities that have not yet done so to take measures to guarantee a dignified death.
Decisions at the end of life are not improvised, they must comply with some values and a concept of dignity that each person must reflect on, share with their family and friends setting, and with professionals, basically those in primary health care. To confront death and leave the end of life decisions established, the best tool is the living will, also known as advance directive document. For this reason, we request the Ministry of Health and the Autonomous Communities to reinforce primary health care through the dissemination and signing of the living will.
From DMD we also urge the appropriate authorities—Ministry of Health and regional Health Councils—to guarantee a palliative care leading to a dignified death free of suffering, both for people who wish to stay at home and for those who are hospitalized, accompanied by their loved ones. Lastly, we understand that funeral rites should be considered essential activities so that a more humane farewell in keeping with our culture is permitted.