Ethical Challenges of Early Identification of Advanced Chronic Patients in Need of Palliative Care: The Catalan Experience

J Palliat Care. 2018 Oct;33(4):247-251. doi: 10.1177/0825859718788933. Epub 2018 Jul 13.


Palliative care must be early applied to all types of advanced chronic and life limited prognosis patients, present in all health and social services. Patients' early identification and registry allows introducing palliative care gradually concomitant with other measures. Patients undergo a systematic and integrated care process, meant to improve their life quality, which includes multidimensional assessment of their needs, recognition of their values and preferences for advance care planning purposes, treatments review, family care, and case management. Leaded by the National Department of Health, a program for the early identification of these patients has been implemented in Catalonia (Spain). Although the overall benefits expected, the program has raised some ethical issues. In order to address these challenges, diverse institutions, including bioethics and ethics committees, have elaborated a proposal for the program's advantages. This paper describes the process of evaluation, elaboration of recommendations, and actions done in Catalonia.

Keywords: advance care planning; chronic conditions; ethics; palliative care; palliative care approach.

MeSH terms

  • Adult
  • Advance Care Planning / ethics*
  • Advance Care Planning / organization & administration*
  • Aged
  • Aged, 80 and over
  • Chronic Disease / therapy*
  • Female
  • Hospice and Palliative Care Nursing / ethics*
  • Hospice and Palliative Care Nursing / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Palliative Care / ethics*
  • Palliative Care / organization & administration*
  • Referral and Consultation
  • Spain
  • Surveys and Questionnaires