Palliative care, which should be used when it is not possible to cure the patient but to alleviate their suffering and accompany them in the process of their illness in a multidisciplinary way, should not only be geared towards adulthood but towards any stage of human life.

Addressing pain and suffering in the earliest stages of human life represents one of the great clinical and ethical challenges of our time. Traditionally, healthcare has tended to extrapolate adult treatment models to the pediatric population, a fundamental error that modern bioethics and pediatric palliative care specialists are striving to correct.

The Italian National Bioethics Committee (CNB), in its  opinion on pediatric palliative care  published in June 2025, insists that care for children must be developed through specific strategies in the clinical, ethical, and organizational spheres. The experts also warn of the need to adapt healthcare services to the specific characteristics of pediatric patients in order to offer comprehensive, high-quality care to both children and their families.

At what age can suffering begin? Recognizing fetal and neonatal pain

For a long time, the absence of structured verbal language led to doubts in the scientific community about the ability of fetuses and newborns to  perceive pain . However, current scientific evidence is conclusive: between 20 and 22 weeks after conception, a fetus’s response to potentially painful stimuli is similar to that of an adult at the behavioral, biochemical, and electrophysiological levels.

This finding has profound bioethical implications. The use of analgesia in early life should be considered not only to alleviate the physical consequences of pain, but also as an ethical imperative to prevent suffering in situations where it is highly likely to occur. Ignoring this fact violates the fundamental right of every human being to be free from unnecessary suffering.

Debunking the myths of pediatric palliative care

Despite being a universally recognized right, it is estimated that, globally, only about 10% of children who need palliative care receive it. As experts from the  Institute for Better Care at the San Juan de Dios Hospital  in Vizcaya state, “this alarming lack of equity is largely due to a lack of resources and the widespread ignorance that stigmatizes this type of care.”

It is imperative to debunk the false beliefs that act as insurmountable barriers. Palliative care is not reserved exclusively for the final moments of life, nor is it equivalent to the prelude to death; in fact, its objective is to ensure the best possible quality of life for the patient from the very moment a debilitating illness is diagnosed. Nor is it a resource exclusively for cancer patients: in clinical practice, 70% of children treated in these units suffer from genetic, metabolic, or neurodegenerative diseases, compared to 30% with cancer.

Pediatric palliative care represents the active and total care of the child’s body, mind and spirit, always extending a support network to their family.

The perinatal dimension and the care alliance

The need to alleviate pain and support those experiencing suffering begins even before birth. When severe fetal anomalies with a limited life expectancy are diagnosed, the healthcare system must offer a coordinated strategy that prioritizes the quality of life of both the pregnant woman and the newborn. The clinical management of these pregnancies requires rigorous interdisciplinary collaboration, integrating gynecologists, neonatologists, geneticists, psychologists, and bioethicists, to prevent families from navigating this difficult process alone.

The recent  “Rome Charter 2026”  crystallizes this ethical vision through ten fundamental principles, reiterating that palliative care is an undeniable civil and social right. Among its tenets are the obligation to ensure that no child suffers unnecessarily, the importance of not abandoning families, the priority of keeping children in their homes whenever possible, and the duty to listen to the child as an integral part of their care.

Children, even the youngest ones, need to trust that they will not be abandoned or deceived. They have the right to receive honest and age-appropriate information about their illness, which is essential to allaying their fears.

Ultimately, ensuring relief from pain and suffering, and access to palliative care from the earliest ages, even prenatally, is not merely an act of medical compassion, but a bioethical imperative and a matter of social justice. Protecting dignity in extreme vulnerability is the true indicator of the humanity of our healthcare system.

In contrast to the Italian model, the scandalous lack of implementation in Spain of policies aimed at providing sufficient quality palliative care to those who need it, at any stage of their lives, constitutes a serious dereliction of the duty to care when it is not possible to cure.

Euthanasia proposals, which tend to extend over time to the pediatric age as well, constitute the unacceptable proposal received by patients who suffer and ask to die without being able to access the alternative of palliative care, which constitutes the true help to live – not to die – that human dignity deserves.

Julio Tudela. Cristina Castillo. Bioethics Observatory. Catholic University of Valencia