**4. Chapter motivation and scientific interest**

After almost 30 years of combining multilingual medical care in three countries with a special interest in *Palliative Care* practiced at all levels of care in the country in which it had its modern origin and at the political-organizational level of the country of origin itself, the pressure to address its expansion from different perspectives: conceptual, semantic and semiotic; anthropological, philosophical, political and welfare, of confronting the intrinsic philosophy seeking what imprints character on a multi -professional attention at the international level at a time when there is great confusion as to what constitutes the delicate spirit of a movement that has its roots in medieval *hospitium*. What remains today in a health system carelessly over-mechanizing its practice within a society that turns its back on the truth of that fluid *charity* of religious orders that knew how to welcome, attend, assist, care for and treat exhausted pilgrims [35] who had undertaken journeys with genuine hardship of those who did not know whether they would be able to return home?

The rigorous search for intangible fundamentals to make them available to all involved, within a strict research framework will result in new knowledge that, made available to all, results in undisputed palliative conceptions and important new paradigms.

The real impact on the defense of life in the context of an announced death is indisputably revealed by the immediate practical applicability of the theories used. These are issues that arouse great interest in acquiring greater knowledge, apprehensible by those who develop their clinical activity in this field.

The Anglo-Saxon *Palliative Care*, known among Spanish speakers as "*Cuidados Paliativos*", changes the perspective from which we see the process of dying and death itself contributing to facilitate vital fullness and that the sick or close individual achieves his or her potential as a person even in the midst of complex multidimensional needs.

Cicely Saunders'original biography [36] relays how she established that one of its the modern Hospice movement underpinning values would be thinking and incorporating "Those who one day will come to join us" referring to professionals from diverse specialties, countries and bringing their own contribution to the field strengthening.

Undoubtedly the urgent demographic need means that many of us allow ourselves to call what is nothing more than a part of the original Palliative Care, a successor of Canadian origin of the previous "Terminal Care" [30, 32]. Contemporary Palliative Care has not made a full conceptual incorporation making, in my opinion, imperative the need to adjust foundational concepts.

International contemporary PC has not always made full conceptual incorporation, making it necessary the effort to adjust current impressions to the

foundational ethos of the discipline, maybe contributing to the serious contemporary problem of PC's lack of expansion in some places, even regressing in some countries unable to take roots in different cultures and new times. A phenomenon that could be contributing to a great confusion of what can be legitimately undertaken to facilitate the end of life.

"What exactly constitutes the ethos of PC faithfully replicating its philosophy and founding principles wherever it is applied or used?" The author concludes that coming to that knowledge would help facilitate possible future advances that integrate ethical, legal and social implications in years to come that truly benefit those

*The Challenges Facing Palliative Care Advocacy: What Is in a Name?*

*DOI: http://dx.doi.org/10.5772/intechopen.97367*

PC delivery and benefits fall under the Philosophy Phenomenological arena while the conceptualization of the main terms on which research is centered around its practice, as the phenomenon investigated. Conceptual construction. Life to its end is a prodigy in progress. Images and s never seen before, thoughts never before thought, realities never dreamed of, constantly emerging, constantly reminding that individual universe that it has not yet reached the limits of its possibilities. The essence of PC could well be life that remains as such, as an evolving universe. Or perhaps the sick person's journey to his deepest self than the professional is more of

To identify themes to be found in the English and Spanish literature a systematic

From those, the summary, the most important ideas to consider include Palliative Care comes to change the perspective from which we see the process of dying and death itself contributing to facilitate the vital fullness and that the sick or close individual achieves his potential as a person even in the midst of complex

Cicely Saunders, as included in her biography [2], spoke of the PC bases would include "Openness to those who will come" referring to professionals from diverse countries and cultures who, one day, would join the Modern Hospice Movement. They would bring new ways to alleviate and contribute their own culture, ways of doing and even different specialties and specific

needs in the final phase of different diseases. Another base was to be the *Freedom of*

Wanting to know what constitutes the essence of PC is a complex task; our search shows the need to do an in-depth analysis of the terminology used and its

A relevant finding was the fact that other concepts such as *essence*, might be used to make reference to what philosophy and ethos bring. "Essence" is a term of alchemy from Latin *essere* (to be), then arguably embodies "meaning", "purpose". From a metaphysical point of view, it could be considered as the possibility of filling the living space of the individual with information gained through

32 Other non-randomized, quasi-experimental, descriptive (comparative, correlation), case–control,

1 Reports or opinions from expert committees or the clinical experiences of respected authorities

1 Systematic reviews and meta-analysis. Controlled Randomized studies

with palliative needs.

a witness than an escort.

multidimensional needs.

conceptual adequacy.

*the Spirit.*

experience.

MESH Terms

2 Thesis

**Table 1.**

**305**

cohort studies

8 Books and Book Chapters 9 Clinical guides, documents

*Palliative care ethos literature review.*

"Palliative" (and) "Care" (and) "Ethos"

search was conducted (**Table 1**).

The IAHPC. Global Consensus based palliative care definition [6], found it necessary to incorporate a glossary to define a long list of terms, an indication of the difficulty to agree on them when used in different languages and settings.

An example of this situation has come to worry many during the current pandemic: While in the Anglosaxon countries it is said to have come of age and helped reinforce services and support colleagues and professionals, in other countries, their activity has been reduced.

The growing interest in the political and institutional sphere PC has fostered in the COVID -19 demands increasing determination in its organizational assistance and political levels. Might It be possible that the careful conceptual clarification of terms common in the palliative field eases their extension and promotion? [36].

The depth of PC ethos, wherever it might lay, should be preserved to some level. Its transformation into *Cuidados Paliativos* is work in progress since 1989 [37] and continues to attract interest to clarify evolving conceptions [38]. It has slowly started moving over the years from *Cuidados* to a broader and less physical *atención*, (attention)*,* to be true to its authentic foundational philosophy and inherent principles, their safeguarding of which should reflect the spirit of the modern hospice movement as it was when St Christopher's Hospice first opened its doors. How it adapts and evolves is a central concern for many, characteristically uneasy about understanding how such ethos could be more widely established and how to prevent it from dissipation until lost, disappearing under the increasing technology laden healthcare services. It is worth getting to know the work undertaken by those for whom intangible aspects matter, precisely because they constitute the hospice movement founding heritage. A particular apprehension is that the "ethos" could be lost by spreading more widely if it is "marketed", while losing its well-founded and carefully established approach to convey its philosophy and principles.

Interestingly, it precisely the collaborative effort between PC and other hospital specialties which is contributing significantly to its interdisciplinary progression and consolidation. The support of classic specialties, which once questioned the specific object of Palliative Medicine, a different entity from PC, is key to its advancement and development.

It is worthy of consideration the fact that Palliative Medicine is the only medical specialty that


It is, therefore hardly surprising its practitioners need to explain what they do and who they are many times a day!

A recent piece work reviews some important milestones in PC's history and development from which Palliative Medicine spirals in many countries; analyses its evolution in the world, studying current issues concerning consistency in its implementation and some possible projections for future progress and expansion, seen from the perspective of a central issue:

foundational ethos of the discipline, maybe contributing to the serious contemporary problem of PC's lack of expansion in some places, even regressing in some countries unable to take roots in different cultures and new times. A phenomenon that could be contributing to a great confusion of what can be legitimately under-

The IAHPC. Global Consensus based palliative care definition [6], found it necessary to incorporate a glossary to define a long list of terms, an indication of the

An example of this situation has come to worry many during the current pandemic: While in the Anglosaxon countries it is said to have come of age and helped reinforce services and support colleagues and professionals, in other countries, their

The growing interest in the political and institutional sphere PC has fostered in the COVID -19 demands increasing determination in its organizational assistance and political levels. Might It be possible that the careful conceptual clarification of terms common in the palliative field eases their extension and promotion? [36]. The depth of PC ethos, wherever it might lay, should be preserved to some level. Its transformation into *Cuidados Paliativos* is work in progress since 1989 [37] and continues to attract interest to clarify evolving conceptions [38]. It has slowly started moving over the years from *Cuidados* to a broader and less physical *atención*, (attention)*,* to be true to its authentic foundational philosophy and inherent principles, their safeguarding of which should reflect the spirit of the modern hospice movement as it was when St Christopher's Hospice first opened its doors. How it adapts and evolves is a central concern for many, characteristically uneasy about understanding how such ethos could be more widely established and how to prevent it from dissipation until lost, disappearing under the increasing technology laden healthcare services. It is worth getting to know the work undertaken by those for whom intangible aspects matter, precisely because they constitute the hospice movement founding heritage. A particular apprehension is that the "ethos" could be lost by spreading more widely if it is "marketed", while losing its well-founded and

difficulty to agree on them when used in different languages and settings.

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

carefully established approach to convey its philosophy and principles.

a. Does not wrap its expertise around an organ, as Cardiology or

an entity such as Infectious diseases or Virology.

Interestingly, it precisely the collaborative effort between PC and other hospital specialties which is contributing significantly to its interdisciplinary progression and consolidation. The support of classic specialties, which once questioned the specific object of Palliative Medicine, a different entity from PC, is key to its

It is worthy of consideration the fact that Palliative Medicine is the only medical

Gastroenterology do; or group by age, as Geriatrics or Pediatrics do; or even

b. Has adjectivized its specialism to qualify the medical expertise offered. c. Is truly transverse across all other areas of expertise, from Neonatology to Neurosurgery passing through Organ Transplantation and Primary Care.

It is, therefore hardly surprising its practitioners need to explain what they do

A recent piece work reviews some important milestones in PC's history and development from which Palliative Medicine spirals in many countries; analyses its evolution in the world, studying current issues concerning consistency in its implementation and some possible projections for future progress and expansion, seen

taken to facilitate the end of life.

activity has been reduced.

advancement and development.

and who they are many times a day!

from the perspective of a central issue:

specialty that

**304**

"What exactly constitutes the ethos of PC faithfully replicating its philosophy and founding principles wherever it is applied or used?" The author concludes that coming to that knowledge would help facilitate possible future advances that integrate ethical, legal and social implications in years to come that truly benefit those with palliative needs.

PC delivery and benefits fall under the Philosophy Phenomenological arena while the conceptualization of the main terms on which research is centered around its practice, as the phenomenon investigated. Conceptual construction. Life to its end is a prodigy in progress. Images and s never seen before, thoughts never before thought, realities never dreamed of, constantly emerging, constantly reminding that individual universe that it has not yet reached the limits of its possibilities. The essence of PC could well be life that remains as such, as an evolving universe. Or perhaps the sick person's journey to his deepest self than the professional is more of a witness than an escort.

To identify themes to be found in the English and Spanish literature a systematic search was conducted (**Table 1**).

From those, the summary, the most important ideas to consider include

Palliative Care comes to change the perspective from which we see the process of dying and death itself contributing to facilitate the vital fullness and that the sick or close individual achieves his potential as a person even in the midst of complex multidimensional needs.

Cicely Saunders, as included in her biography [2], spoke of the PC bases would include "Openness to those who will come" referring to professionals from diverse countries and cultures who, one day, would join the Modern Hospice Movement. They would bring new ways to alleviate and contribute their own culture, ways of doing and even different specialties and specific needs in the final phase of different diseases. Another base was to be the *Freedom of the Spirit.*

Wanting to know what constitutes the essence of PC is a complex task; our search shows the need to do an in-depth analysis of the terminology used and its conceptual adequacy.

A relevant finding was the fact that other concepts such as *essence*, might be used to make reference to what philosophy and ethos bring. "Essence" is a term of alchemy from Latin *essere* (to be), then arguably embodies "meaning", "purpose". From a metaphysical point of view, it could be considered as the possibility of filling the living space of the individual with information gained through experience.


**Table 1.** *Palliative care ethos literature review.*
