Maija Miettinen: Are recommendations sufficient to improve palliative care in Finland?

How can palliative care and terminal care be strengthened so that the final phase of life is as good as possible? We have been working on this in the working group for several months now.

Palliative care means active and comprehensive care aimed at providing relief from symptoms, given to a terminally ill patient to alleviate suffering and to improve the quality of life at a time when the progression of the illness is inevitable. The last phase of palliative care is called terminal care, which provides care, help and support in the last weeks of life.

When Parliament rejected the citizens' initiative to legalise euthanasia in 2018, it required the Government to set up a broad-based expert working group. The working group was tasked to examine good care, self-determination, terminal care and euthanasia in the final phase of life and make proposals on the regulatory needs.

The work of the expert working group is now more than halfway through, and it is time to review the progress of the work.

More expertise in palliative care is needed and regional differences need to be levelled out

The working group has agreed that before discussing the regulatory needs of euthanasia, the current situation of palliative care must be mapped out and shortcomings rectified.

The results of the survey published last year are clear: more expertise in palliative care is needed and there are clear regional differences in the availability of high-quality palliative care.

An expert recommendation on palliative care was published on the basis of the survey. According to the report, care to relieve symptoms and terminal care must be available from care units to specialised medical care. The recommendation emphasises that the implementation of care that provides relief from symptoms is one of the basic skills of every social and health care professional.

Are recommendations sufficient to rectify the shortcomings, or are changes to legislation needed?

At the end of last year, the expert working group set up a so-called legislative working group, which has drawn from a report on the regulations and recommendations concerning palliative care in a number of foreign countries. The working group considers that securing high-quality palliative care for all those in need also requires legislative amendments, and has now made a preliminary proposal for the necessary changes.

To support its work, the working group organised at the end of February a hearing in which stakeholders had the opportunity to express their views on the preliminary proposal. The opinions reiterated the view that recommendations alone will not be enough to correct shortcomings in palliative care, but that changes to legislation are also needed.

According to the preliminary timetable, the draft amendments will be completed by early autumn 2020. The expert working group will then discuss them and decide on further work.

High-quality and timely care reduces unnecessary visits to emergency care services

Competence, process development and financial investment are needed to implement the recommendations and possible legislative amendments.

Next, the expert working group will prepare an estimate of the costs incurred in implementing the necessary changes. In addition to direct costs, it is of paramount importance to take into account alternative costs – high-quality and timely palliative care can generate savings by reducing, for example, visits to emergency care services that do not benefit the patient.

Better access to receiving care at home and in residential care homes also helps to preserve individuality and human dignity until the end of life.

Maija Miettinen
Secretary of Experts, working group of experts on end-of-life care