Dr Eduardo Bruera, oncologist and world leader in palliative care, is also known as the father of this specialty, which promotes the physical and emotional benefits of a multidisciplinary intervention focused on the patient and their families. In this interview he explains the key role of palliative care in improving the quality of life for people with advanced diseases and the importance of incorporating palliative care in the education of future physicians and in management of health institutions.

What is the status of palliative care in Spain?

Although I do not work actively here, I have a very close relationship with the Spanish Palliative Care Society (SECPAL) and I have watched the development of palliative care over the years. Unfortunately, Spain has the same problem as the Argentine football team, which has extraordinary players, but a bad association, and therefore they always have issues. And currently, I believe that Spanish health organisations have not given the resources to the extraordinary clinicians that would allow them to express themselves academically in hospitals. Therefore, what needs to be changed is the “Football Association” and not the professionals. Why don’t hospital directors, faculty of Medicine deans, private hospital managers have independent palliative care services?

What is currently lacking in this area in Spain?

I believe that the most important thing is the lack of institutional support for the professionals who are dedicating their career and their lives in this area. Spain still doesn’t have a palliative care specialty. In fact, it is one of the few developed countries in the world that does not have this specialty and I believe that this is causing huge issues for health professionals, for patients and their families.

I can’t quite understand what the obstacle is that is preventing it, but obviously there is a cultural issue that is keeping the system from adopting independent supportive and palliative medicine departments in all universities, schools, and hospitals. It would be advisable to find out what the barriers are and develop new strategies.

Do you think that the implementation of this specialty must be addressed in an interdisciplinary way?

Yes, without a doubt. doubt. The relief of human suffering not only involves interventions by the physician, nurse or psychologist. It goes through the architect who designs a building, through the one who plays the music, the one who changes the lighting. It goes through the economist who understands how palliative care saves, rather than causing losses in society. It goes through the philosopher and theologian who understands that providing relief from suffering as a moral priority and goes through several related university disciplines that must help develop the techniques we need to properly teach this subject.

Why is palliative care so important?

Because the relief of human suffering is one of our priorities as human beings, it is part of what makes us humane. In other words, solidarity in the face of the suffering of another person is what dignifies me as a person, and studying how to do this, studying how to perfect myself to be a caregiver, apart from being a worker, is one of the best investments that I as a student can make.

When a family member has cancer, the whole family is sick. The family is sick emotionally, economically, spiritually and physically from the additional tasks they must do. This family sickness is what requires universities and hospitals to know how to help the family find relief in the physical, social and spiritual aspects. That this relief from suffering is not a theoretical thing, but a thing one applies daily.

Another problem we have right now is that not everyone who needs palliative care has access to it for economic issues.

It is certainly one of the paradoxes, because if I, an oncologist, see a cancer patient, I have two options: option one is to spend the next hour with the patient and their family, contemplating the prognosis of the disease, the options for treatment, all from the advantage of being at home without having to go to the hospital continuous testing. Option two is to spend only five minutes to briefly tell the patient that we are going to prolong treatment for one more month and we will run more tests and see what happens in the next three or four weeks.

The current system and the clinical and administrative pressure lead me to the second option, and as a result, this person will undergo extremely expensive treatments, x-rays and laboratory tests, without receiving any support care. This way, the money goes to the pharmaceutical companies. But, if the patient receives support and palliative care, a portion of that money will also go to all those who help the patient who is suffering. Not only would we be saving huge amounts of money, but we will also be reinvesting in our own people, rather than investing in a US or German technology company.

There is a long wait time to access palliative care in Spain. How do you think this could be solved?

The solution lies in the investment. Money, not words, is what is needed and show that this money, in the long run, can be recovered many times over, with fewer expensive treatments, less radiology, fewer days of hospital admission …. I would like to be able to tell politicians that this can be done for free, but it is done with discipline and with investment, not in the pharmaceutical or electronics company, but in hiring people to provide this care.