[The physician's role in various clinical contexts. The physician's role in palliative care]

The palliative care physician accompanies patients and their families in times of great disstress and potentially difficult medico-ethical decision making. The main objective of palliative care is the alleviation of pain and distressing symptoms in patients with progressive, incurable illness. By addressing physical problems and psychosocial as well as spiritual needs, palliative care aims at improving the quality of life of patients in order to help them to spend their remaining lifetime with as much autonomy as possible and in dignity. The concept of accompaniment in palliative care involves a multiprofessional team. Important factors in this approach are time, trust, professional, ethical, communicative, social, and emotional competencies and the attitude of physicians and other professionals. The physician is given responsibility by the patient. In accepting the role as a respondent to another individual's request for help, the physician can avoid the pitfalls of the obsolete paternalistic relationship model, or of one that is either merely autonomy based or of a provider-customer nature.