A group of physicians and other health care experts are working with the Vatican to promote what they see as a sorely needed form of "advanced medical care" -- palliative care, which is centered on pain relief and emotional, spiritual and social support of patients with chronic, progressive diseases.

Under the auspices of the Pontifical Academy for Life, 13 experts from eight countries spent more than a year developing a "white paper for palliative care advocacy," which was published in late September by the Journal of Palliative Medicine, a peer-reviewed publication.

Dr. Carlos Centeno, director of the Atlantes Research Group at the University of Navarra, Spain, and coordinator of the experts' group, told reporters Sept. 27 that palliative care is "advanced medicine for the end of life," a form of medicine that relies less on technology and more on human contact and a team approach to patient care.

Dr. Thomas Sitte, chairman of a German foundation devoted to palliative care, said that in his country, "we have a problem with over-treatment, over-treatment until the very end" of a patient's life.

Often that treatment is aggressive, excessive and painful, which almost naturally weakens the patient's desire to live and increases the family's suffering as well, he said. Palliative care is not a soft form of euthanasia, but it does accept the fact that some illnesses cannot be cured.

Centeno said that in some parts of the world palliative care and hospice care are nearly identical, especially because "the same spirit is behind them, the principles are the same: holistic care, family involvement, a team approach and patient-centered care."

Identifying individuals or categories of people to lobby and drawing up proposals, the 13 experts first looked to national policy makers, urging efforts to provide universal access to palliative care.

"Patients with chronic progressive diseases, such as cancer, congestive heart failure, chronic obstructive pulmonary disease and HIV-AIDS develop severe physical, psychosocial and spiritual symptoms before death," they said. Palliative care can reduce much of their suffering, and "there is strong evidence that these benefits are accompanied by a reduction in the total cost of care."

The experts called for mandatory undergraduate courses in palliative care for all medical and nursing studies and for the development of certification guidelines for health care workers specializing in palliative care.

They also urged a special role for pharmacists in the palliative-care team since most patients will need to take multiple drugs and will have an increased risk of negative drug interactions.

Speaking to reporters, Sitte also highlighted the report's insistence that governments and hospitals take seriously the World Health Organization's identification of morphine as an "essential medicine."

"Globally, a majority of patients die with severe pain without having ever received a single dose of morphine or other opioid analgesic," the report said. Obviously the "abuse potential and adverse effects" must be considered and the drugs must be handled with care, but there is no other drug as effective in treating pain, especially in patients with cancer.

Governments and health care providers must "recognize access to pain relief and palliative care as a basic right of the person and the family," the report said.