Qualità della vita e dignità della persona con dolore cronico persistente: il ruolo delle cure palliative

Felice E. Agrò

Sommario: 1. Introduzione. 2. Antropologia del dolore. 3. Obiettivi di fine vita. 4. Principi etici. 5. La morte. 6. L’eutanasia. 7. Aspetti medici delle cure palliative. 7.1. L’approccio ai sintomi più frequenti alla fine della vita. 7.1.1. L’astenia. a) Terapia dell’astenia. b) Controllo dell’anemia. c) Controllo del dosaggio di farmaci. d) Terapia farmacologia. e) Terapie non farmacologiche. 7.1.2. Il dolore. a) Note di epidemiologia. b) Patogenesi. c) Clinica del dolore oncologico. 7.1.3. Sintomi neuro-psichiatrici. a) Disturbi del sonno. Confusione mentale e sintomi psicotici. a) Disordini mentali. b). Terapia dei disordini mentali. d) Depressione. e) Terapia della depressione. 7.1.4. Sintomi gastrointestinali. a) Anoressia. b) Terapia dell’anoressia. c) Nausea e vomito. d) Alterazioni della motilità intestinale. 7.1.5. Lesioni cutanee. a) Trattamento delle lesioni cutanee. 7.1.6. Infezioni ricorrenti. a) Sintomi. b) Prevenzione. c) Trattamento. 7.1.7. Alterazioni idroelettrolitiche. a) Terapia. 7.1.8. I sintomi alla fine della vita. a) La sedazione terminale. 8. Cure palliative: approccio globale al paziente. 8.1. Il team di cure palliative. 8.2. Cure palliative in regime di assistenza domiciliare. 8.3. Concetto e significato di hospice.

Abstract: The progress of medicine in the more developed societies has led to an increase in the number of curable diseases.  Other incurable diseases have been rendered treatable.  The overall result has been a lengthening of the average lifespan and an increase in the number of patients with chronic progressive diseases which inevitably constitute situations that are very complex to handle.  Palliative care consists in the ensemble of therapies administered to patients who do not respond to causal treatments.  The purpose of palliative care is to attain the best quality of life for the patients themselves and for their families.  Palliative care is a multidisciplinary therapeutic model for a global approach that includes the consideration of not only the physical but also the psychological, social and spiritual aspects of a patient afflicted with incurable progressive disease and of the family members who look after him.  The model, which is applied over the course of the disease, consists in all those treatments aimed at maintaining an acceptable quality of life or at least the reduction of the sufferings of the patient and his family.  The approach of death should be characterized by the intensification of palliative care, avoiding therapeutic overkill and always seeking to guarantee maximum serenity in a difficult moment of life.  To care for an individual who needs palliative care means being alert to his suffering, alleviating it through definite, highly specialized and low-cost medical treatments, respecting the human being in his personal dignity.

Keywords: palliative care, personal dignity, ethics, philosophy of medicine.