[Palliative medicine]

Palliative medicine has its origin in the modern hospice movement. It is based upon an integrated-care concept for seriously ill and dying patients. The first consideration of this particular form of treatment is not to prolong life, but to reach the best possible quality of a patient's remaining lifetime. Therefore, palliative medicine consists of: (1) excellent pain treatment and symptom control; (2) an integrated approach towards the psychic, social, and spiritual needs of the patient, relatives, and attending staff during the periods of illness, dying, and, after the patient's death; (3) competence in dealing with vital matters of communication and ethics; and (4) acceptance of death as a normal process. Palliative medicine clearly rejects euthanasia. Practical implementation of the idea of hospice services can be realised anywhere when taking care of seriously ill and dying patients, whether at home, in a nursing home, or in hospital. Experience shows that quite a few patients cannot be treated successfully without additional services, such as home-care services, day-care centres, in patient hospices, and palliative-care units. Up to now, severely ill tumour patients have benefited most from these services. In palliative care units an interdisciplinary team of doctors and nursing staff assisted by physiotherapists and members of psycho-social professions is taking care of and treating patients. Additional support is given by voluntary services and the integration of the patient's relatives in the caring process. Palliative medicine is the overall term for this special kind of treatment and care. In Great Britain, Canada, and Scandinavia considerable progress has been achieved in this field, including recognition as an independent clinical discipline and the establishment of lectureships in palliative medicine.