Palliative Care: A model for innovative health and social policies

From the European Association of Palliative Care

Resolution on palliative care, adopted on 29th of January by the Parliamentary Assembly of the Council of Europe.

Rapporteur: Wolfgang Wodarg


The Parliamentary Assembly of the Council of Europe has unanimously adopted the resolution produced by mr. Wodarg as a part of his report: Palliative care, a model for innovative health and social policies. The report states clearly the need for the development of palliative care in all European countries, to make palliative care available for all patients with life threatening diseases who need it.However, the report does not only support palliative care as a comprehensive approach for severely ill and dying patients.

It commends palliative care as an innovative new way, which can be used as a model for other areas of health care. Setting flexible goals of therapy for the individual patients, and more important, setting these goals in close communication with the patient, as well as supporting the autonomy of the patient and enabling him to experience autonomy even with increasing physical or cognitive impairment are important issues that palliative care can contribute to other areas of health care. In consequence, the report and the explanatory memorandum discuss the importance of ethical concepts such as autonomy or allocation of resources in detail.

The Parliamentary Assembly recommends that member states should promote palliative care as a key pillar of care provision. Rewards for non-product related services should be introduced as incentives to a chieve this. The Assembly also recommends strengthening the contribution from primary More specifically, the Parliamentary Assembly recommends member states to promote symptom control not only in palliative care, but also in the domain of curative medicine, In addition, indicators for progress as well as annual reports should be useful tools for the improvement of palliative care in Europe. There are only few points in the resolution that merit critical discussion.

The report takes into account available surveys on the status of hospice and palliative care in Europe. However, it is based in many parts on the German experiences, and decision makers in other European countries may find it difficult to accommodate all recommendations within the setting of their national health system. Whereas the impact of volunteer work in hospice and palliative care and the need for the involvement of the primary care sector does receive adequate consideration and acknowledgement in the report, the participation of specialized professionals is also of major importance and should not be neglected.

Most general practitioners treat only very few palliative care patients per year, and may lack knowledge and skills to relieve symptoms adequately, deliver psychosocial and spiritual care and coordinate the care for complex cases. In many European countries model projects have demonstrated the efficacy of counselling and care services led by specialists, networking with general practitioners and other carers and service providers in the area. EAPC has given considerable input to the report, from the head office as well as from the Task Force on Development led by Carlos Centeno and David Clark. Information from the Atlas of Palliative Care produced by that Task Force was used as an important resource on the current status of palliative care in the different European regions. We hope that the resolution and the report will archieve wide dissemination, and that it will be used by national governments and by national and regional stakeholders to guide and foster the development of hospice and palliative care. The goal is to make adequate provision of palliative care available to all those who need it, regardless of the economical, social or cultural setting. Setting up a continuous communication with the political structures in Europe will be a major focus of EAPC in the next years to pursuit this ultimate goal.

Prof. Dr. Lukas Radbruch(President of EAPC)