Cultural issues and ethical dilemmas in palliative and end-of-life care in Spain.
BACKGROUND
The concept of palliative care differs according to cultures and traditions. In Spain, palliative care programs have expanded in recent years. The European Commission Research Project in Palliative Care Ethics has sponsored ongoing research to analyze and clarify the conceptual differences in providing palliative care to patients in European countries with diverse cultures and backgrounds.


METHODS
The authors present key ethical issues in clinical practice in palliative and end-of-life care in Spain and how these issues are influenced by Spanish culture. They discuss typical characteristics of the Spanish conceptual approach to palliative care, which might be relevant in an even larger Latin palliative care context.


RESULTS
The cultural tradition in Spain influences attitudes toward euthanasia, sedation, the definition of terminality, care in the last 48 hours of life, diagnosis disclosure, and information. The overall care of terminally ill patients with an Hispanic background includes not only the treatment of disease, but also the recognition and respect of their traditions and culture.


CONCLUSIONS
The Spanish palliative care movement has shifted its focus from starting new programs to consolidating and expanding the training of the professionals already working in the existing programs. Although there is a general consensus that a new philosophy of care is needed, the interpretation and application of this general philosophy are different in diverse sociocultural contexts.
Núñez Olarte
J M
JM
Palliative Care Unit at the Hospital General Universitario Gregorio Maranon 28007 Madrid, Spain. jmluque@radonc.hggm.es.
Guillen
D G
DG
D003466:Cultural Characteristics; D004992:Ethics, Medical; D005006:Ethnicity; D005065:Euthanasia; D006291:Health Policy; D006801:Humans; D010166:Palliative Care; D012924:Social Conditions; D013030:Spain / Q000208:ethnology; D013727:Terminal Care