Palliative care is the ethical commitment of a society that is sensitive to the suffering of its citizens. When medicine has failed to prevent or cure an illness, it must commit to caring for and supporting those who suffer from it in order to alleviate their suffering. It is then that we must consider the ethical dimension of care through the five ethical imperatives of palliative care:

1. Respecting the patient’s wishes and values ​​is paramount. Listening is the best way to understand their final wishes and values, and thus fulfill their desires regarding how they wish to be cared for. We can use ongoing dialogue with the patient or an advance directive when they are unable to express their wishes personally.
2. Never abandon the patient or their family . Although we are sometimes unaware of it, we can abandon the patient in several ways: through insufficient doses of medication (which we call “therapeutic abandonment”), through a lack of training in palliative care and not knowing what to offer to alleviate their suffering, or by not dedicating the time they need to share their concerns with us. But the most irresponsible and unempathetic way to abandon the patient and their family is with the phrase “there’s nothing more we can do.” It would be different if we said, “we can’t cure their illness, but we can still do many things to continue caring for them.”
3. Relieving and treating the symptoms that cause suffering . Preventing the suffering caused by symptoms is the fundamental goal of palliative care. If we focus on pain, the primary symptom in the advanced stages of an illness, we must bear in mind that its management is not optional for the physician; it is a legal and ethical obligation. The patient has the right to pain relief, and we have the duty to provide it. The patient themselves will indicate the effectiveness of the pain relief when they tell us, “Doctor, I’m no longer in pain.”
4. Adjusting diagnostic and therapeutic efforts . In the case of a terminal illness, diagnostic tests and treatments that would be useless in that situation and would undoubtedly prolong unnecessary suffering should be avoided. A treatment indicated and required in curative medicine may be contraindicated in palliative care, such as cardiopulmonary resuscitation.
5. Sedation is used when symptoms are refractory . Some patients, despite all treatments employed, experience one or more symptoms that are refractory to treatment, causing unbearable suffering. This compels the physician to reduce the patient’s consciousness to ensure a peaceful death. When a physician sedates a terminally ill patient, using clinical and ethical criteria, they are not causing death, but rather preventing suffering as the patient dies. Palliative sedation neither shortens life nor delays death; it merely reduces the patient’s consciousness so they cease suffering until their time comes. The disease will continue its natural course. Sedation , in itself, is simply another neutral therapeutic resource and therefore ethically neutral. What can make it ethically acceptable or reprehensible is the intended purpose and the circumstances under which it is applied; the purpose of sedation is the measure by which the act is judged as ethical.

To conclude this article, I wish to reiterate that palliative care does not aim to hasten death, nor to prolong unnecessary suffering, but rather to accompany the patient to alleviate their suffering until death arrives. And that this care is the best way to experience dying, because palliative care helps us live, provides quality of life during the dying process, and also strengthens the bonds of affection with loved ones and helps give meaning to life.

Dr. Jacinto Bátiz Cantera. Director of the Institute for Better Care at San Juan de Dios Hospital in Santurce. Trustee of the Pía Aguirreche Foundation. Head of the Bioethics Working Group of the SEMG (Spanish Society of General Practitioners).