The first recommendations under the project “Advancing Human Rights through Improved Palliative Care Services”

Within the project entitled “Advancing Human Rights through Improved Palliative Care Services”, which SUPRAM conducts in partnership with the Center for Palliative Care and Palliative Medicine – BELhospis from Belgrade, supported by the donors of the Balkan Trust for Democracy ( http://www.gmfus.org/program/balkan-trust-democracy) and the Embassy of the Kingdom of Norway in Belgrade (https://www.norway.no/en/serbia/ ), a field research was conducted in seven focus groups and three cities in Serbia, from March to the end of June 2019. The project is approved for a period of 12 months aiming to provide important results, recommendations and proposals for regulation and policy changes in the field of palliative care and care for seriously ill and old in Serbia.

Legal analyzes that followed the field research gave the first recommendations in the field of medical-legal treatment, quality of care, intersectoral cooperation between providers of health and social services, as well as administrative and court proceedings related to patients and their family members. These are given as follows:

1. Medical law aspects in the palliative treatment of dying patients

The special position of persons who are at the final stage of the illness and in a serious state of health should not, considering their vulnerability, diminish their legal protection. On the contrary, they need additional protection. Dying patients should enjoy all the basic patient’s rights in accordance with the law. There must be no discrimination on either the health status nor by the social status, such as for example, marginalized groups.

Human dignity must be respected which is guaranteed by the Constitution of the Republic of Serbia where all forms of inhuman treatment are forbidden.

In the practice of palliative care, all patients’ rights need to be respected, particularly, the right to informed consent, either personally, through a legal representative, a family member or another person. The form of the patient’s advance decision should be legally supported.

It is necessary to continue working on legislation improvement, as well as protocols and best practice guides, in order to contribute better practice in dealing with dying patients.

2. Health and social care services in palliative care – competencies and cooperation

Ensure optimal availability of all levels of palliative care and care through adequate organizational models at the primary, secondary and tertiary level of health care;

Provide conditions regarding the possibility of engaging an additional number of doctors and health staff (nurses and technicians) in home care and primary care services (health centers), as well as in palliative care units at the secondary level of health care (hospitals);

Importance of appropriate coordination in the field of palliative care and treatment, establishing the professional bodies for palliative care, and strengthening intersectoral cooperation, as well as cooperation with citizen associations;

Creation of preconditions for palliative treatment and care in social care institutions;

Enable and strengthen the cooperation between health care and social care institutions in terms of palliative care and services;

Establish the funds for the purchase of appropriate equipment (e.g rolling stock), drugs and medical devices, required by palliative care providers;

At the national level, it is necessary to develop a policy and legal framework in health care regarding palliative treatment in cooperation with health workers, social workers, citizens’ associations, patients and their families.

3. Palliative care – assistance in administrative and court procedures

It is of special importance that potential beneficiaries of palliative care and members of their families (and even the general public) are appropriately informed which judicial or administrative proceedings may be initiated in order to exercise some of the rights to palliative care. Furthermore, to facilitate the initiation and management of these procedures through the assistance of institutions of health and social care protection, as well as other state bodies and providers of palliative care services, and to develop the cross-sectoral cooperation between the entities concerned.

To ensure that legal remedies for the protection of the rights of palliative patients are available to users in less developed environments and to all social strata.

To take the procedure of deprivation of liberty of a person with the need for palliative care carefully, or to apply this remedy restrictively only to the extent that it is necessary, and in these situations, wherever possible, caregivers are placed from a circle of close relatives and persons who take care of the sick.

Notice: The urgency of procedures for exercising the rights of persons with the need for palliative care by prescribing short deadlines (24 hours up to a maximum of 3 days) in which the judicial and administrative authorities must conduct the procedure and make a decision, as well as on strict control of the deadlines must be guaranteed. Also, simplification of procedures must be undertaken in order to secure the protection of patients rights.