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BMJ. Jan 6, 2001; 322(7277): 8.
PMCID: PMC1119339

Spain agrees palliative care plan

A national plan on palliative care has been agreed by the Spanish ministry of health and the health departments of the Spanish regional governments. The goal is to enable terminally ill patients to receive treatments in their own homes to improve their quality of life but not necessarily extend life.

The plan regulates, for the first time in the country, the use of opiates to mitigate pain in terminally ill patients, even though the secondary effect may be a shortening of life.

Celia Villalobos, minister of health, said that the approved plan is a “response to ageing of population and in particular to the increasing number of cancer cases.” The plan focuses on the incidence of cancer, which caused 90000 deaths in Spain last year, and points out that the number of patients with chronic and degenerative diseases and AIDS will increase in the next few years.

Dr Antonio Pascual, president of the Spanish society of palliative care, says that there are major inequalities in current services as more than half of Spain's palliative care teams are based in Madrid and Catalonia. An objective of the new plan is that the access to palliative care is similar nationwide “without distinction of territory, economic resources or information.”

The plan states that “doctors have been reluctant to administer opiates in the terminally ill and that public health authorities have also shown resistance to provide them,” even though “such resistance has diminished in recent years.” Pascual says that the consumption of opiates, especially morphine, is low in Spain—10 kg per million people a year, less than half that in the United Kingdom.

The plan will increase the number of palliative care units currently existing in the country—at least eight Spanish provinces currently have none.


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