“Palliative care is about putting people first,” says Professor Juho Lehto

The term “palliative” comes from pallium, the Latin word for cloak. The word reflects the goal of palliative care to cloak the patients and their loved ones in a protective layer of care and comfort, as explained by Juho Lehto, a Professor of Palliative Medicine at Tampere University.

“The processes in our society and healthcare system must be closely intertwined to ensure this cloak effectively shields and supports patients approaching the end of their lives, as well as their families. This encapsulates the essence of palliative care. If that cloak is like a haphazardly designed patchwork quilt, a collection of disjointed elements, it offers protection for no one.”

Consequently, Lehto worked hard in 2023 to ensure the Palliative Care Centre and Hospital-at-Home were brought under one roof within the Wellbeing Services County of Pirkanmaa. Pirkanmaa Hospice, the regional hospice care provider, is an affiliated component of the Palliative Care Centre. The Hospital-at-Home delivers hospital-level, multiprofessional care to patients either in their homes or assisted living facilities.

Nowadays, almost all the wellbeing services counties in Finland have a dedicated palliative care centre that coordinates end-of-life care and provides specialist guidance for medical professionals. Significant steps have been taken to increase access to palliative care and improve its quality in Finland.

“When resources are limited, pooling expertise to redistribute staff across units is the best option to address staff shortages and maintain a tolerable balance. Palliative care teams need enough time to provide high-quality care,” Lehto says.

While significant improvements have been made in palliative care in Finland, we have not yet reached the finish line. The ongoing reduction in the number of hospital beds nationwide presents additional challenges.

“Care services and hospital-at-home programmes do not eliminate the need for hospital beds. While patients may prefer to die at home, some will need hospitalisation towards the end of their life.  Hospital beds should be available at a reasonable distance from their family members.”

Palliative care is preventive medicine

Palliative care involves active, holistic support provided to patients with incurable or life-threatening illnesses and their families. Its goal is to prevent and relieve suffering while maintaining patients’ quality of life. This care can extend over months or even years. The final stage of palliative care is end-of-life care, where patients typically have a life expectancy measured in days or weeks. 

“Palliative care might not seem beneficial at first glance because the patients can no longer be cured. However, it is a major achievement if we can make patients comfortable and help them maintain the quality of their remaining life. In fact, providing palliative care is very rewarding,” Lehto says.

According to Lehto, the philosophy of palliative care places compassion and human dignity at its centre, along with an understanding of humanity and care that goes beyond traditional medical perspectives. Wellbeing encompasses multiple dimensions, many of which lie beyond the scope of medicine.

“Paradoxically, patients often experience an improvement after their burdensome disease-centred treatments are over. When the goal of care is concentrated on the professional management of symptoms and psychosocial support – the protective cloak – patients and their families may begin to feel better, at least for a while.”

Photo: Jonne Renvall

Lehto firmly believes that medicine is a tool and people are the priority. Doctors need to understand the basis of treatments and make treatment decisions in collaboration with, and in the best interests of, their patients. While medical expertise is an important tool in this process, communication with patients is what builds bridges between scientific knowledge and human care. It plays a pivotal role in making sure patients feel heard and cared for.

“As absurd as it may sound, high-quality palliative care is a form of preventive medicine. The quality of patients’ end of life has an enormous impact on the well-being of their loved ones. In fact, end-of-life care has two goals: to accompany patients towards death and ease their family members back into life.”

No absolute criteria for euthanasia

The question of euthanasia often arises when discussing the final stages of life and the alleviation of suffering.

A study published in January 2024 by Tampere University and the Finnish Medical Association shows that slightly more than 50% of doctors in Finland are either fully or partially in favour of legalising euthanasia. Despite this, the Finnish Medical Association reaffirmed its opposition to euthanasia. In April, the national broadcasting company Yle reported on the results of a survey it commissioned from the market research company Taloustutkimus, demonstrating that four in five people living in Finland support euthanasia.

According to the study by Tampere University and the Finnish Medical Association, doctors like Lehto – those who have specialised in palliative medicine and have ample experience of treating patients with an incurable illness – tend to be more strongly opposed to euthanasia. Lehto explains that this result may be due to palliative care specialists having more tools and knowledge for relieving patients’ suffering.

“Thanks to high-quality palliative care, we see many patients experience a peaceful end of life and death, which is generally the case at the population level. This may lead palliative care specialists to question the need for legalising euthanasia, considering all the associated risks and challenges.” 

Lehto highlights the complexity of euthanasia, noting that it is perceived differently from the perspectives of individuals and broader populations. While euthanasia may in some cases offer benefits to some individuals, the challenge lies in creating clear criteria and effective laws and guidelines as regulating euthanasia is difficult.

“Politicians and people often say they are in favour of euthanasia as long as there are strict and clear eligibility criteria for accessing voluntary assisted dying. I find this to be a misunderstanding. Doctors can predict how long a patient might live and assess whether their suffering can or cannot be alleviated, but they can never be absolutely certain about these things. Legalising euthanasia would mean accepting the intentional ending of life based on probabilities. This is why the practice of euthanasia has a tendency of expand to cases we may not have originally intended. Personally, I hold a critical stance towards euthanasia, but I understand the perspective of its supporters. I believe my role is to work with my research group to provide new insights into the euthanasia debate and clarify what is truly at stake when considering its legalisation.”

Photo: Jonne Renvall

Humane care takes time

Delivering high-quality palliative care necessitates a substantial workforce of medical professionals. It requires a dedicated team of nurses and doctors who are not overburdened and who possess specialist expertise in palliative care. Palliative care is a part of the broader social and healthcare services spectrum, not an isolated entity, and faces the same challenges as other sectors.

“When time and resources are limited, our focus often shifts to medical interventions and seemingly efficient care, whereas providing humane end-of-life care requires time and attention. There should be a legal clause safeguarding access to palliative care in Finland, as wellbeing services counties tend to prioritise statutory services when resources are tight,” Lehto says. 

Besides, no form of resource management or clever trick will eradicate the need for palliative care. With an ageing population, more people are dying in Finland than before.

“We need to remember that these are people and families that we must care for, one way or another. The question is whether we do it smartly or not. In the absence of palliative care, terminally ill patients would rely on acute care hospitals or emergency rooms, for example. The costs would be unquestionably higher. Even though cost-efficiency might seem like an offensive term in this context, investing in palliative care has both humane and economic benefits.” 

Basic medical education is what ultimately weaves the fabric of the protective cloak that is palliative care. Lehto is pleased with the progress made in palliative care education, a field in which he has played a significant role: he co-led the EduPal spearhead project, implemented by the Ministry of Education and Culture from 2018 to 2021, to provide national recommendations for a curriculum on palliative medicine and create a specialist training programme in palliative care for nurses.

“As virtually all clinicians encounter patients who are terminally ill, they need to have a basic understanding of palliative medicine and recognise it as an essential part of their work. However, as palliative medicine is not among the specialities that receive the largest research grants from the pharmaceutical industry, its development relies on public investment and support from universities. This support enables us to conduct high-impact research and provide high-quality education.”