Palliative care: pathway in primary health care in Brazil

Abstract

In 2022, an important international report was published on the “value of death” not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, and the global trends in opioid consumption of International Narcotics Control Board of the World Health Organization, in which opioid consumption in Brazil is in the hundreds of doses per million inhabitants per day. Despite notable advances in the legislative and executive fields with regard to palliative care, the Brazilian Unified National Health System (SUS) and primary health care have suffered important structural setbacks that will impact the design of public policy for palliative care. The goal of this article is to undertake an initial analysis of the impacts of current policies within this context and their repercussions in the construction of a solid policy for palliative care.

Shared decision-making: why, for whom, and how?

“…Starting with a necessary and relevant joint position of the Brazilian National Academy of Palliative Care (ANCP) and the Brazilian Society of Geriatrics and Gerontology (SBGG) on shared decision-making in palliative care 10 . Followed by an important article pointing out the importance of palliative care for Public Health and its importance in primary health care 11 . As the authors show, the irregular advance of access to palliative care in Brazil reflects the lack of a public health policy organizing and structuring this field of knowledge in the country.…”

Decisión compartida: ¿por qué, para quién y cómo?

“…Comenzando por un necesario y relevante posicionamiento conjunto de la Academia Nacional de Cuidados Paliativos (ANCP) y de la Sociedad Brasileña de Geriatría y Gerontología (SBGG) sobre la toma de decisiones compartidas en cuidados paliativos 10 . A conti-nuación, se presenta un importante artículo que llama la atención sobre la importancia de los cuidados paliativos para la Salud Colectiva y su importancia en la atención primaria de salud 11 . Como muestran los autores, el avance desigual del acceso a los cuidados paliativos en Brasil es un reflejo de la falta de una política pública de salud que organice y estructure esta área del conocimiento en el país.…”