End-of-life care does not help patients die, it removes fear and pain, says palliative specialist

“We do not help patients die.” That is the central message from Vincenzo Di Francesco, head of geriatrics at Verona Hospital and coordinator of Help, a multidisciplinary group created to organize hospital-based palliative care. Palliative medicine, he says, is not about death. It aims to protect a patient’s physical, psychological and spiritual well-being, and quality of life, through the final day.

Help tries to identify the need for palliative care as early as possible, while patients are still receiving treatment for their illness. This approach, known as simultaneous care, addresses pain and other difficult symptoms caused by treatment, while also helping patients understand what is happening and decide what to do. “We take care of the person, not the disease,” Di Francesco says.

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We do not help patients die, but guarantee their psychophysical and spiritual well-being and their quality of life until the last day.

Palliative care becomes the only remaining option when symptoms become refractory, including uncontrollable vomiting, unbearable pain and severe breathing difficulties. Doctors may use pain treatment and sedation to reduce suffering, fear and distress. Deep sedation can be used in the terminal phase of serious illnesses such as cancer, Alzheimer’s disease and advanced kidney or respiratory conditions, when suffering outweighs the benefit of keeping the patient conscious. Di Francesco stresses that this is not euthanasia, but a medical technique for reducing intolerable suffering.

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We take care of the person, not the disease.

He says deep sedation is used only for a small proportion of terminally ill patients. Its purpose is to allow them to sleep without pain, agitation or air hunger, and it does not hasten death. In his account, when performed properly, it can even lengthen survival. Patients do not necessarily remain in hospital: 70% return home with support from palliative doctors and nurses in the community, while the rest move to hospices.

Access has expanded in the Verona area. Fifteen years ago, Di Francesco says, the province had only one palliative specialist. It now has 25. Help sees about 300 patients a year, which he describes as only the tip of the iceberg. Around 10,000 people with chronic illnesses in Verona could need palliative care, although not all are terminally ill. Cancer patients now account for 60% of the group’s patients, even though palliative care began in oncology.

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It is not euthanasia, but a medical technique that reduces intolerable suffering.