Articles of opinion, research studies or reports of Scientific Societies in relation to care for the patients at the end of life have been numerous in recent months.

It is an issue which is of concern to citizens and health proffesionals. Health institutions and services have not succeeded in producing processes that, based on scientific knowledge and respecting the preferences of patients, improve coordination of treatments, care and spiritual care requiring patients and their families.



Thus, the journal New England Jornal of Medicine in its issue of February 12, 2015 published several articles about.

In End-of-Life Advance Directives we are invited to reflect and send feedback on a practical case in which arises what specialist could arrange the best way of decision-making with the patient and care planning. How, when and where. At first glance we could suggest a coordinated care, but it is interesting to read the arguments of each proffesional.

Another interesting item is the revision of laws and American programs related to end of life care in the last 40 years. Both in this text (Forty Years of Work in End-of-Life Care – From Patient´s Rights to Systemic Reform) as in other of the same number (Should we practice what we profess? Care near the End-of-Life) it is cited the report Dying in America del Institute of Medicine (IOM), whose basic recommendations are:

1. Providing comprehensive and coordinated palliative care.

2. Improving communication with the patient and care planning.

3. Training on aspects related to the end of life.

4. Institutional programmes focusing on the patient care.

5. Information for citizens to achieve their involvement.

Reading these articles should invite us to reflect in a first step and then act.

Clinical Bioethics could be interesting and entertaining. This is one of the aspects to improve: Bioethics as pure entertainment, when in essence should be action.


To act essentially we need to read, listen, reflect, discuss, propose and finally implement programs and processes that improve health care.

With the ill person as objective.

Dr. Iñaki Saralegui (@InakiSaralegui)
Intensive Care Unit. Hospital Universitario de Alava.
Chairman of the Medical Ethics Committee
Bioethics Working Group – SEMICYUC
inaki.saraleguireta@osakidetza.net