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The colours of Palliative Medicine


25 | 10 | 2021



FotoManuel Castells

Dr Carlos Centeno uses an anecdote he told his nephew to explain palliative medicine. "When he was little, we used to play at storytelling. One of us would start the story and the other would have to follow it," he recalls. "One day, I started talking about a green dragon and my nephew immediately stopped me to correct me: "the dragon is coloured", I remember him saying. That's what palliative medicine is also like: colourful," he says confidently.

In the picture

Dr. Carlos Centeno is the scientific coordinator of the Palliative Medicine research line of Strategy 2025.

The colours to which Dr. Centeno refers are the values that, although intangible, they touch every day.

They are the professionals involved in palliative care; in this case, the interdisciplinary team led by Centeno, made up of doctors, nurses and psychologists, but also researchers from the social sciences and the Humanities: historians, philologists, a social worker...

The values are human dignity, gratitude, love between people; the dedication and generosity of professionals, who stay with a sick person beyond what is strictly necessary; and the positive tone in dealing with suffering.

And these are the values that the University's research line in Palliative Medicine seeks to disseminate in society and among professionals , as part of its Strategy 2025

"We want to get the message of palliative medicine, which is a message of values, across to society," explains Carlos Centeno. development "And to do this we are working on three strategic lines: researching the values themselves, documenting the reality of palliative care in the world (which has crystallised in the ATLAS Palliative Care projects) and studying the logic of the message itself. 

"The University wants to contribute to what is worthwhile, to what concerns society today".

At the University of Navarra the research in Palliative Medicine started in 2006 when the Clinic Support Team was initiated. Later, in 2008, it was incorporated as subject to the Degree of Medicine and in 2012 the group of research interdisciplinary ATLANTES was launched at the. Institute for Culture and Society

Today at the University, a significant number of professors and researchers work in the field of Palliative Medicine, with a clear desire to cooperate with other institutions with similar objectives and different perspectives. As Carlos Centeno explains, "the University looks at society and feels the need to give back what it receives from it, contributing to what is worthwhile, to what is of concern today. And there is no doubt that the social situation, the advanced age of European populations and the way in which the end of life has been approached in recent years is a hot spot.

In the picture

Carlos Centeno leads a team multidisciplinary, made up of doctors, nurses and psychologists, but also of researchers in the social sciences and Humanities: historians, philologists, a social worker...

Dr Centeno argues that palliative medicine is advanced medicine. "Some people say: "but you don't do anything"," he complains, but with a smile. "We don't do anything in the sense that we don't use a technique, a device, a diagnostic test ...", he acknowledges. "What we do is actively care . Evaluate. Identify problems. Giving support. And to accompany, not only the patient, but also the family. And this requires advanced medicine. And he explains: "You have to know a lot about pain and symptom management. You have to know how to use the drugs available. You have to know a lot about the emotional component of the person to identify what is happening: if the patient is discouraged or demoralised, if the problem is in adapting to the process.... You have to know how to communicate. And you have to know how to respond to the ethical questions that we often face. And all of this requires research," he concludes. 

In Spain, Palliative Medicine began to develop in the 1990s and did so strongly. Until 10 years ago. "Then, everyone forgot about it," Centeno recalls. "It has only been now, following the discussion debate on euthanasia, that we have remembered that the terminally ill have needs and we have started to talk about palliative care. The problem is that we often don't know what we are talking about. When referring to palliative medicine, old concepts are often used, thinking that it is applied to those who are going to die, when there is nothing more to do. "Palliative medicine is very active," replies Dr Centeno. "People are surprised when they find out that we treat patients at enquiry. But what we do is alleviate the intense suffering of those who have a serious illness. That is palliative medicine today. 

That is why it is not black, not even grey. Although Carlos Centeno acknowledges that in his day-to-day work as a palliative care doctor there are intense and difficult moments, when asked what is the hardest thing about his profession, he is clear: "The hardest thing is to see suffering and not to relieve it. And we see that sometimes. But to see someone die peacefully? That's not hard at all. It can even be beautiful and comforting. When you see someone arrive at your enquiry in a situation of emotional stress, fear, confusion... and little by little, that complex, difficult situation unravels, and that person advances in the process of acceptance, or at least of adaptation, and comes to die in peace.... There is nothing hard about that: it is very beautiful and very comforting. And it is something worth dedicating one's life to: to ensure that more and more people have the necessary support to make the journey that we will all have to make one day". 

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The Global Palliative Care Observatory ATLANTES coordinates for WHO a set of indicators to assess and monitor development palliative care worldwide.