Fifty years of commitment to palliative care: the Milan Charter to relaunch it
The aim is to transform good standards into enforceable rights for a healthcare system that measures its value not only by survival rates but by the dignity with which it accompanies each person through illness
by Francesca Crippa*
We live in a time when medicine achieves extraordinary things. Yet it is precisely this medicine capable of prolonging life, of intervening on the most complex diseases, that risks losing what makes it profoundly human, the capacity to recognise the limit, to alleviate and not to abandon: palliative care.
Palliative care is a set of medical, nursing, psychological, spiritual and social interventions and support aimed at reducing overall suffering in order to improve the quality of life of the sick person and his or her family. Although the term may make one think of something residual, they are by no means a surrender, but rather the clinical, civil and ethical response to humanity's oldest and most inescapable need: to cure when healing is no longer possible. In our country, palliative care owes much to the Fondazione Floriani, which half a century ago launched the first pain therapy service at the National Institute of Tumours in Milan. In the mid-1970s, engineerVirgilio Floriani, an entrepreneur to whom we owe the development of radio links with the important company Telettra, faced his brother's incurable illness and experienced at first hand the dramatic abandonment of cancer patients (an unpronounceable word at the time) for whom 'there is nothing more to be done'. Thanks to a meeting with the pain therapist Vittorio Ventafridda he decided to commit himself, with a substantial bequest, to the creation of a foundation dedicated to providing answers to the treatment needs of incurable patients. This gave rise to a pioneering multidisciplinary model (doctors, nurses, physiotherapists, social and spiritual assistants) that over the years has directly or indirectly cared for over 100 thousand people and has become paradigmatic for the rest of the country.
The road travelled led to the important milestone of Law 38 of 2010, to whose realisation the foundation also contributed, which defines palliative care as an acquired right, an Essential Level of Care. In reality, to this day this important right in practice is not always enforceable. This is why the Floriani Foundation on the anniversary of its 50th anniversary, proud of its achievements, feels the need and duty to draw attention to what is really still missing and to chart a course for the future. In Italia today, being able to benefit from good palliative practices still depends on where one lives, one's age, the type of diagnosis or the ability of the health system to organise itself.
It is thus that this dutifully enforceable right is often transformed into an unfulfilled promise: a failed cure. Hence the need to come up with a document that relaunches on what still needs to be done, starting from our city that saw the birth of Italian palliative care, which we have called the 'Milan Charter'.
This Charter, presented at the Feltrinelli Foundation by Professor Silvio Garattini, invites us to take a step of collective maturity in order to transform good norms into truly enforceable rights for a healthcare system that measures its value not only by survival rates but by the dignity with which it accompanies each person through illness, frailty, the advanced phase of life, until the end.
