The emergence of palliative care has fuelled the debate surrounding patient autonomy at the end of life. In recent years, the media has increasingly addressed issues relating to ethics, pain relief and quality of life, and these topics have attracted attention in palliative care scientific meetings and other professional forums.³⁶

Nevertheless, there is a growing consensus that end of life issues should be discussed more fully: a position strengthened by the growing debate surrounding euthanasia and physician assisted suicide. Eisenchlas and De Simone write:

‘it is imperative that the medical profession ask itself what their members are doing in relation to end of life care, what teaching should be provided in medical schools and spread the debate across society. We believe it is necessary not only to increase knowledge and arguments for debate, but also to consider the emotional and cultural aspects of the subject and promote a multidisciplinary debate on the issues involved.’³⁷

Freedom of choice is compromised for patients in Argentina due to:

a) a patriarchal/protective presence of family members in medical decision-making
b) a paternalistic attitude towards patient care on the part of physicians
c) the strong influence exerted by the Catholic Church on public debate
d) a lack of communication skills among health care professionals.

During consultations with terminally ill patients, a ‘conspiracy of silence’ frequently envelops any discussions relating to diagnosis, ‘fatal’ prognosis, dying and death. The family wishes to protect the patient from ‘unnecessary suffering’ whereas the patient wants ‘to mitigate the spiritual pain’ in the family. Although mentioned as a barrier to effective doctor-patient communication at the bedside, ‘traditional families’ have nevertheless been an invaluable resource for the development of home care programmes.

Issues and priorities

Several factors jeopardize palliative care developments in Argentina, including the following:

a) lack of an operational network among palliative care providers
b) weak links between palliative care providers and other vested interests
c) the absence of palliative care standards and professional certification
d) concerns about opioids addiction and the mythical view of morphine as the “last resort”
e) difficulties in obtaining and paying for certain drugs eg alternatives to morphine
f) low (sometimes no) salaries for palliative care professionals
g) a shortage of funds to run services and extend professional qualifications
h) difficulties guaranteeing volunteer work and charitable funding
i) a lack of recognition of palliative care needs at the national level
j) insufficient palliative care provision within the health system,
k) bureaucracy, passivity and inequality regarding health resources; their distribution, availability and allocation,
l) a failure to address issues surrounding death and dying

Despite these many barriers, palliative care developments in Argentina lead the way in South America. Activists continue to raise the awareness levels of both society and government. Opioid consumption has increased over the last ten years and in 2001, Argentina recorded the highest morphine consumption in the region. The challenge now facing Argentina is to integrate palliative care into the national health systems, to continue to change the attitudes of both society and the medical profession, and to increase the coverage and availability of palliative care.