Continuing education in the healthcare field is an ethical and professional duty assumed by all those dedicated to healthcare. However, a key training gap persists: palliative care. This article reflects on the urgent need to incorporate this discipline into the basic training of all healthcare professionals, not only as a technical tool, but as an inescapable ethical commitment. Real-life cases demonstrate how a lack of preparation in this field can translate into attitudes of abandonment, self-sufficiency, or fear, with direct consequences for the quality of life of patients in advanced stages of their illness. Palliative medicine cannot be a pending subject: it is an essential investment in humanity, professionalism, and justice.

As healthcare professionals, we recognize that continuing education is essential to maintain our professional competence and keep it up-to-date, enabling us to effectively assist patients in their treatment and recovery. The Code of Medical Ethics (OMC, 2022), in its Article 77.1, reminds us that this continuing education is a deontological duty: “Continuing medical education is a deontological duty, a right, and a responsibility of all physicians throughout their professional lives.”  But I will not address this in this article because I assume that all of us dedicated to healthcare have internalized it and practice it.

What I will address is the need to also train ourselves in palliative care, because many of our patients cannot be cured, but will continue to need our help to alleviate their suffering and accompany them until the end. Therefore, we have an ethical commitment to training ourselves in palliative care to better care for them.

Not all healthcare professionals need to be true experts in palliative care, just as we aren’t experts in diabetes, hypertension, pediatrics, geriatrics, etc. But we should have basic training in each of the clinical situations our patients face so we can offer them our support. If the problems they present are complex, then experts will be the ones to handle them.

Some negative attitudes

There are situations in which a lack of training in palliative care can lead to negative attitudes toward patient care. Let’s give some examples.

A young doctor who had recently completed her oncology residency and is now an attending physician in the Oncology Department of a major hospital saw a patient with a very advanced oncological process with no curative treatment options and who could only be helped with palliative care. When she assessed the patient, she felt she was facing a complex situation and decided to avoid it, leaving the patient and their family to their own devices, understanding that palliative care should only be applied during the final stages. The young doctor was unaware that palliative care should be offered from the first moment of diagnosis of the fatal disease and that it can be administered simultaneously with curative treatments, and that palliative care is intensified as these treatments prove ineffective. Under no circumstances should palliative care wait until the final stages are reached to apply palliative care. Her lack of training in palliative care led her to abandon the patient and their family to the suffering caused by the advanced oncological disease from which they suffered.

In addition to the attitude of abandonment   in the previous case, another attitude derived from the lack of training is that of  self-sufficiency, considering the situation to be trivial and of little complexity and that it can be easily managed with minimal technical knowledge and attention to the physical symptoms.

An example of this professional self-sufficiency is demonstrated by a highly prestigious specialist physician with many years of care experience, but who had no training in palliative care. He was asked to care for a patient with an advanced respiratory illness who was unresponsive to any treatment. The patient was deeply afraid of suffocating from lack of air and of dying; he also did not want to be admitted to the hospital so as not to be far from his family and loved ones. The specialist in question considered that he was facing a trivial and relatively uncomplicated situation that could be easily managed by him with minimal technical knowledge and attention to the physical symptoms. This self-sufficiency on the part of the physician led him to ignore other needs of his patient, which he should also have been trained to address, such as providing help with the patient’s fear of dying and his decision-making skills with the patient regarding his refusal to be admitted to the hospital.

The third attitude resulting from a lack of training in palliative care is the attitude of fear. This happened to an internist who was known for his diagnostic success. In this case, he encountered an elderly patient in the terminal stages of dementia and a family who wanted to take her home so she could die peacefully with them. However, the doctor, faced with fear and reluctance to accept his patient’s terminal condition, adopted more interventionist approaches to hydrate and nourish her.

Well, these three attitudes (abandonment, self-sufficiency, and fear) can and do lead to the person at the end of life and their family suffering from a lack of comprehensive care during the dying process, a lack of home support, and a shortage of ongoing care. However, there is encouraging evidence that these attitudes can be avoided with the knowledge and skills acquired through ongoing training in palliative care.

Palliative medicine has acquired sufficient clinical and scientific significance to be taught in all medical schools by professors who can demonstrate sufficient training and clinical experience. This reflection is in line with the directives of the European University Area, which consider palliative care a pending subject.

Any institution’s investment in training its professionals in palliative care or in engaging with university institutions in training will be a highly profitable investment in ensuring better care for patients and their families. Caring for sick people is not an optional matter for professionals; it is an ethical imperative.

Dr. Jacinto Bátiz Cantera  – Director of the Institute for Better Care  –  San Juan de Dios Hospital in Santurce (Vizcaya)  – Patron of the Pía Aguirreche Foundation