Biolaw and coercive limits: analysis of palliative care regulations

Abstract

Bioethics regulations are essential for the development of palliative care in Brazil. This study aimed to identify Brazilian regulations on palliative care and analyze their coercive limits. A qualitative and quantitative documentary study was conducted from September 2024 to March 2025, involving searches in government databases and repositories of federal university hospitals. The results showed the absence of federal laws on palliative care. At the state level, only 16 states (59.2%) had legislation on this topic, totaling 24 regulations (two with coercive limits). In hospitals, only 17 units (37.7%) had regulations on palliative care, totaling 37 regulations (six with coercive actions). The joint analysis identified 64 regulations on this topic, with only nine (14%) containing coercive limits. A gap in federal legislation on palliative care was found. Brazilian states and hospitals need to advance in the regulation of palliative care. Finally, the scarcity of coercive regulatory actions raises uncertainties about their effectiveness.

Keywords:
Bioethics; Palliative care; Guidelines as topic

Resumo

As normativas do biodireito são primordiais para a evolução dos cuidados paliativos no Brasil. Este estudo objetivou identificar normativas brasileiras sobre cuidados paliativos e analisar seus limites coercitivos. Realizou-se uma pesquisa documental qualiquantitativa, entre setembro de 2024 e março de 2025, com buscas em bases governamentais e repositórios de hospitais universitários federais. Os resultados evidenciaram a ausência de leis federais sobre cuidados paliativos. Também se verificou que, no âmbito estadual, apenas 16 estados (59,2%) tinham legislação nesse tema, totalizando 24 normas (duas com limites coercitivos). Nos hospitais, somente 17 unidades (37,7%) apresentaram regulamentação sobre cuidados paliativos, perfazendo 37 normas (seis com ações coercitivas). A análise conjunta identificou 64 normas nessa temática, das quais apenas nove (14%) continham limites coercitivos. Constatou-se uma lacuna na legislação federal sobre cuidados paliativos. Os estados brasileiros e os hospitais necessitam avançar na regulamentação a respeito desse cuidado. Por fim, a insuficiência de ações coercitivas normativas traz incertezas quanto à sua efetividade.

Palavras-chave:
Bioética; Cuidados paliativos; Diretrizes normativas

Resumen

La normativa del bioderecho es fundamental para evaluar los cuidados paliativos en Brasil. Este estudio identifica la normativa brasileña sobre cuidados paliativos y analiza sus límites coercitivos. Se realizó una investigación documental cualitativa y cuantitativa entre septiembre/2024 y marzo/2025, en bases de datos gubernamentales y repositorios de hospitales universitarios federales. Los resultados evidenciaron la ausencia de leyes federales sobre cuidados paliativos. Únicamente 16 estados (59,2%) tienen legislación sobre este tema, con 24 normas (dos con límites coercitivos). Solo 17 unidades hospitalarias (37,7%) presentaban regulaciones sobre cuidados paliativos, lo que sumaba 37 normas (6 con acciones coercitivas). El análisis conjunto identificó 64 normas sobre este tema, solo nueve (14%) contenían límites coercitivos. Se constató una laguna en la legislación federal sobre cuidados paliativos. Los estados brasileños y los hospitales necesitan avanzar en la regulación de los cuidados paliativos. La insuficiencia de medidas coercitivas normativas genera incertidumbres sobre su eficacia.

Palabras clave:
Bioética; Cuidados paliativos; Guías como asunto

The improvement of living conditions, combined with technological advances and greater access to health care services, has contributed to the growth of the world population. Data gathered by the United Nations (UN) indicate that, by 2024, the world’s population is expected to exceed 8.2 billion and peak at 10.3 billion by 2080. After this period, a significant increase is expected in the population aged over 65 years, which, by the end of the 2070s, should exceed the number of children and adolescents ¹.

This situation is followed by a higher prevalence of chronic pathologies, an increase in impairing clinical conditions and aging of patients, a conjuncture in which palliative care is essential to ensure quality of life ².

This demographic transition will lead to the coexistence of several generations, marked by different historical and cultural traditions, which will need to relate with tolerance and solidarity. To this end, it is essential to define an ethical and normative minimum that favors a harmonious coexistence ³. This context shows the importance of bioethics as a tool for mediating generational conflicts, fostering respect for differences and self-determination of the human person as an affirmation of individual rights ⁴.

If bioethics refers to the ethical implications of biomedical technology and health-related practices ⁵, biolaw is the legal field responsible for dealing with bioethical issues, configuring the normative compendium of the interrelation between law and bioethics ⁶. Understanding these concepts expands the capacity for ethical action within legal parameters established and accepted by society.

The intersection of these areas supports the role of bioethics in palliative care, especially in upholding patient autonomy and respect for human dignity, principles that should guide decision-making on treatment and the patient-family-health care team relationship ²,⁷. To this end, there are mechanisms such as informed consent and advance directives ³, which are part of the available normative options.

Brazil has extensive legislation on autonomy and health care ⁸, but its coercive power is often relegated to the background. However, the application of this mechanism seeks to ensure civil order and the coexistence of individual rights, indispensable to life in society, as well as compliance with the law through sanctions and restrictions, beyond personal decisions and choices ⁹,¹⁰.

Brazilian regulations for palliative care must be integrated into the legal framework and contain all legal characteristics, including coercive limits, otherwise they will not be fully effective.

Considering the above, there arise questions about how Brazilian legal norms regulate palliative care, as well as about the existence of coercive limits that enforce effective compliance with them.

In this context, this study aimed to identify federal and state regulations related to palliative care and analyze the coercive mechanisms provided for their application.

Method

This study is a qualitative and quantitative documentary research, whose data were collected between September 2024 and March 2025.

There was extensive survey on palliative care regulation in Brazil’s Federal Constitution ⁸, as well as complementary laws, ordinary laws and other infra-legal rules (ordinances, resolutions, internal regulations and operational protocols) at the federal and state levels.

The searches were carried out in the databases of the National Congress, in the Portal of the Brazilian Federal Legislation of the Presidency of the Republic, in the Legis Health system of the Ministry of Health, in the electronic portals of the state legislative assemblies and in the institutional repositories of the university hospitals that are part of the hospital network of the Brazilian Company of Hospital Services (EBSERH).

The search terms used included the Portuguese terms “cuidado paliativo” and “cuidados paliativos,” without restriction for the date of publication of the regulations; however, for inclusion in the analysis, this regulation should be in force at the time of the research. There was no restriction on the number of laws found, and the accuracy of the findings was verified to avoid interpretation biases.

The analysis of the selected content included a thorough reading of the legal text, proving its relevance to the issue of palliative care and seeking to identify the existence of legal measures or administrative sanctions that would characterize a coercive action for application of the standard.

The results were ordered by levels of coverage, classifying the rules according to type, date of approval, body of origin, syllabus or summary, existence of coercive limits in their text and, if so, sanction or coercive action provided for.

The frequencies were presented in absolute numbers or in percentage values, according to the need to establish a comparison between these results.

The authors of this analysis actively participated in the design of the research and its conceptual bases, contributing to the review of the methodological process and correlating the content analyzed with the bioethics and biolaw frameworks. This study was not submitted to the evaluation of the research ethics committee because it uses data that are publicly available on electronic platforms.

Results

The analysis of federal palliative care regulations showed the absence of federal laws (complementary laws, decrees or provisional measures) on end-of-life care. The Ministry of Health published three regulatory ordinances ¹¹-¹³ that addressed this palliative issue.

Of these regulations, as detailed in Chart 1, only Ordinance 3,681, of May 7, 2024 ¹¹, provided for coercive action, consisting in the possibility of disaccrediting the accredited palliative care team in case of non-compliance with the obligation to maintain continuous records of its activities, in order to prove its health care productivity before an audit by the Ministry of Health ¹¹.

Chart 1
Federal palliative care regulations

Type	Identification*	Origin	Syllabus	Limit**	Coercive action
Ordinance	Ordinance 3,681, of May 7, 2024 11	Ministry of Health	Establishes the National Palliative Care Policy (PNCP) within the scope of SUS.	Yes	II – There is no interruption in records for a period exceeding 45 days, under penalty of disaccrediting the team.
Ordinance	Ordinance 5,333, of September 5, 2024 12	Ministry of Health	Changes to January 1, 2025 the deadline for start of the decentralization procedure for the States and Federal District of the accreditation of services and teams, contained in the National Policy on Palliative Care.	No	NA
Ordinance	Ordinance 2,085, of September 9, 2024 13	Ministry of Health	Establishes standards for the registration of Palliative Care Teams in the National Register of Health Care Establishments and includes procedures in the SUS Table of Procedures for Medicines, Orthotics, Prostheses and Special Materials.	No	NA

• SUS: Unified Health System; NA: Not applicable; *Identification of the standard and date of its approval by the competent authority; **Limit: Existence or not of a coercive limit in the text of the regulation

It is also noted that all current federal ordinances related to palliative care were published in 2024.

Chart 2 shows the state regulations on palliative care in Brazil. Considering the 27 federal units (26 states and the Federal District), a total of 16 (59.2%) had some legislation on end-of-life care.

Chart 2
State palliative care regulations

Type	Identification*	Origin	Syllabus	Limit**	Coercive action
Ordinary law	Law 8,871, of June 16, 2023 16	Alagoas	Provides for the institution of precepts and fundaments for palliative care in the state of Alagoas.	No	NA
Ordinary law	Law 2,812, of January 24, 2023 17	Amapá	Establishes the state policy on palliative care in the state of Amapá and adopts related measures.	No	NA
Ordinary law	Law 6,326, of July 27, 2023 18	Amazonas	Provides for principles and guidelines for actions geared toward palliative care within the public health care system of the state of Amazonas.	No	NA
Ordinary law	Law 6,601. of November 27, 2023 19	Amazonas	Institutes the Palliative Care Awareness-Raising Campaign in the state of Amazonas.	No	NA
Decree	Decree 5,977, of February 26, 2025 20	Espírito Santo	Institutes the state palliative care policy in the Unified Health System and establishes other provisions.	No	NA
Ordinary law	Law 19,723, of July 10, 2017 14	Goiás	Institutes the state palliative care policy and amends Law 16.140, of October 2, 2007, which provides for the Unified Health System – SUS, the conditions for the promotion, protection and recovery of health, the organization, regulation, inspection and control of corresponding services and establishes other provisions.	Yes	Art. 13. Failure to comply with the provisions of this Law subjects the offender to the penalties: I - warning; II – fine; and III – interdiction of establishment.
Ordinary law	Law 22,072, of June 28, 2023 21	Goiás	Amends Law 19,723, of July 10, 2017, which establishes the State Policy on Palliative Care and amends Law 16,140, of October 2, 2007, which provides for SUS.	No	NA
Ordinary law	Law 11,123, of October 7, 2019 22	Maranhão	Establishes state guidelines for the implementation of palliative care geared toward patients with life-threatening diseases.	No	NA
Ordinary law	Law 11,509, of September 9, 2021 23	Mato Grosso	Creates the state palliative care program in the public health care system of the state of Mato Grosso.	No	NA
Ordinary law	Law 5,922, of July 11, 2022 24	Mato Grosso do Sul	Includes the state palliative care week in the official calendar of events of the state of Mato Grosso do Sul.	No	NA
Ordinary law	Law 23,938, of September 23, 2021 25	Minas Gerais	Provides for principles, guidelines and goals for State actions geared toward palliative care in public health care.	No	NA
Ordinary law	Law 12,651, of May 23, 2023 26	Paraíba	Establishes the state policy on palliative care in the state of Paraíba and establishes other provisions.	No	NA
Ordinary law	Law 13,017, of December 29, 2023 27	Paraíba	Includes the palliative care awareness-raising week in the official calendar of events of the state of Paraíba.	No	NA
Ordinary law	Law 20,091, of December 19, 2019 28	Paraná	Provides for the institution of precepts and fundaments for palliative care in the state of Paraná.	No	NA
Ordinary law	Law 21,531, of July 3, 2023 29	Paraná	Institutes the palliative care awareness-raising week to be celebrated annualy in the second week of October.	No	NA
Ordinary law	Law 21,997, of June 4, 2024 30	Paraná	Amends Law 20.091, of December 19, 2019, which provides for the institution of the precepts for Palliative Care in Paraná.	No	NA
Ordinary law	Law 16,803. of December 27, 2019 31	Pernambuco	Amends Law 16.241, of December 14, 2017, which creates the Official Calendar of Events and Commemorative Dates of the State of Pernambuco, defines, sets criteria and consolidates the Laws that instituted State Commemorative Events and Dates, including the State Palliative Care Day.	No	NA
Ordinary law	Law 18,014, of December 20, 2022 32	Pernambuco	Establishes the state palliative care policy in the state of Pernambuco.	No	NA
Ordinary law	Law 18,516, of April 16, 2024 33	Pernambuco	Establishes the obligation to release on the state of Pernambuco Department of Health website an informative booklet or material on Pediatric Palliative Care and other provisions.	No	NA
Ordinary law	Law 18,802, of December 30, 2024 15	Pernambuco	Provides for the mandatory release of informational and educational material on the structure and organization of palliative health care, and establishes other provisions.	Yes	Art. 3. Failure to comply with this Law will give rise to administrative liability.
Ordinary law	Law 8,425, of July 1, 2019 34	Rio de Janeiro	Creates the state palliative care program in the public health care of the state of Rio de Janeiro.	No	NA
Ordinary law	Law 15,277, of November 3, 2019 35	Rio Grande do Sul	Institutes the state palliative care policy and establishes other provisions.	No	NA
Ordinary law	Law 1,669, of April 25, 2022 36	Roraima	Establishes principles, guidelines and goals for state actions geared toward palliative care in public health care in the state of Roraima.	No	NA
Ordinary law	Law 17,292, of October 13, 2020 37	São Paulo	Institutes the state palliative care policy and establishes other provisions.	No	NA

• Art.: Article; SUS: Unified Health System; NA: Not applicable; *Identification of the standard and date of its approval by the competent authority; **Limit: Existence or not of a coercive limit in the text of the regulation

Ordinary laws predominated among state regulations on the issue (95.8%), and we found 23 laws and 1 decree that addressed palliative care-related matters, including public policies, prevention campaigns, and expected principles and precepts for the area. The survey also showed that five Brazilian states (18.5% of the federative units) had more than one law on the subject, with the oldest legislation dating from 2017. However, only two state regulations ¹⁴,¹⁵ had some coercive limit in case of possible non-compliance (8.3% of the total state regulations).

The study also included the federal university hospitals of the EBSERH network, whose units totaled 45 organizations distributed in the country. Of these, 17 (37.7%) presented some regulation on palliative care, specifically action protocols, operational procedures, technical manuals, booklets and internal regulations.

The research identified 37 different norms about palliative treatment in these university hospitals; however, only six (16.2%) provided for some coercive mechanism in their text, all of which were represented by internal regulations.

Chart 3 describes these hospital rules with coercive limits, showing that the actions identified ranged from administrative sanctions to the exclusion of patient care follow-up in case of non-compliance with the follow-up of the palliative care team.

Chart 3
Palliative care regulations with coercive actions in university hospitals of the EBSERH network

Type of standard	Origin	Syllabus	Coercive action
Internal regulation 38	HULW/UFPB	Internal Regulations of the Palliative Care Committee of the Lauro Wanderley University Hospital, of June 20, 2022	Art. 11 Dismissal is established when there is definitive removal of a member by decision of the Committee at an Ordinary Assembly, including the fact in the Minutes. Art. 27 Any PCC Member who fails to attend 03 (three) consecutive assemblies, without justification, will be dismissed from the Committee and must be replaced.
Internal regulation 39	HDT/UFTO	Internal Regulations of the Palliative Care Committe of the Hospital for Tropical Diseases, of July 7, 2022	Art. 16. Committee members who are unjustifiably absent from three consecutive assemblies may be dismissed and consequently replaced.
Internal regulation 40	HU/FURG	Internal Regulations of the Permanent Palliative Care Committee of the Dr. Miguel Riet Corrêa Jr University Hospital, of August 15, 2022	Art. 15 Members who, without justified reason, fail to attend three consecutive assemblies or five assemblies in a period of one year without justification will be dismissed.
Internal regulation 41	HC/UFG	Internal Regulations of the Palliative Care Committee of Hospital das Clínicas, of September 9, 2022	Art. 13. Members who, without justified reason, fail to attend three consecutive assemblies or six interspersed assemblies within a period of one year will be dismissed. Sole Paragraph. Failure to comply with the role delegated to the executing group Coordinator within the stipulated period and without justification accepted by the Superintendence will result in compulsory replacement of said coordinator, in case of recurrence or if deemed appropriate.
Internal regulation 42	HUAC/UFCG	Internal Regulations of the HUAC Palliative Care Committee, of September 15, 2022	Art. 18. Committee members who, without justifiable reason in writing, fail to attend three consecutive assemblies or six interspersed assemblies in one year will be automatically dismissed from the committee
Internal regulation 43	HUJBB/UFPA	Regulations of the Oncology Palliative Care Service of the João de Barros Barreto University Hospital, of November 11, 2022	Art. 8. Palliative Care team follow-up exclusion criteria: I. Voluntary refusal of the patient and/or their legal guardian and II. Patients who did not attend, without justification, at least two appointments with the palliative care team. Sole paragraph: Recurring absences are considered as abandonment of treatment if not clarified.

• Art.: Article, PCC: Palliative Care Committee; FURG: Federal University of Rio Grande; HC: Hospital das Clínicas; HDT: Tropical Diseases Hospital; HU: Dr. Miguel Riet Corrêa Jr. University Hospital; HUAC: Alcides Carneiro University Hospital; HUJJB: João de Barros Barreto University Hospital; HULW: Lauro Wanderley University Hospital; UFCG: Federal University of Campina Grande; UFG: Federal University of Goiás; UFPA: Federal University of Pará; UFPB: Federal University of Paraíba; UFTO: Federal University of Tocantins

Concisely, this study identified a total of 64 regulations on end-of-life care, observed at the state and federal levels (including university hospitals in the EBSERH network), but only nine regulations (14%) had some coercive limit for application.

Discussion

The end of life is a challenging stage of human existence, both for patients and their families and for the health care team that participates in care. Ethical values should be emphasized in this health care team-patient-family relationship, not being only restricted to technical criteria, but also recognizing patient need and autonomy in the decision-making process.

The technical and methodological resources that exist in biolaw, including doctrines, laws and infra-legal regulations, are essential to connect the ethical and legal aspects necessary for the practice of palliative care. In this context, coercive actions cannot be disregarded when building and applying palliation regulations, at risk of not being effective and being restricted to mere recommendations without final practical effect ⁹,¹⁰.

The results showed the absence of a federal law on palliative care, which can be attributed to the recent introduction of the issue in our context. In this regard, it is noted that palliative medicine was recognized as an area of medical practice in the country in 2011 ⁴⁴, that is, just over a decade ago.

Comparing with the legal apparatus of other nations, Portugal has Law 31/2018 ⁴⁵, which regulates the rights of people in the context of advanced and end-of-life diseases, providing for mechanisms that value the patient autonomy in decision-making, especially as to informed consent and living will. In Latin America, on July 5, 2022, Argentina sanctioned Law 27,678 ⁴⁶ – National Palliative Care Law –, guaranteeing patients access to palliative care and emphasizing the application of the principles of equity, respect for human dignity and autonomy. However, Colombia was the pioneering country in the region; in 2014, it approved Law 1,733 ⁴⁷, known as the Consuelo Devis Saavedra Law, which regulates palliative care services and ratifies the patient’s right to refuse treatment and have their will respected.

The legal comparison with the situation of these other countries emphasizes Brazil’s need for to advance in the discussion of this issue and initiate this normative journey with the formulation of a federal law.

This gap in federal legislation can delay the evolution of palliative care policies in the country, in addition to hindering the standardization of actions in a nation with continental dimensions. On the other hand, the Ministry of Health showed effort to regulate the matter through the publication, in 2024, of three ordinances ¹¹-¹³. It is worth noting that only one of them ¹¹ presented some coercive resource to ensure its application, albeit incipiently and limited to administrative sanctions.

The analysis of state regulations showed that 59.2% of the federative units had some law on palliative care, indicating a regulation still under development on the subject and warning of a potential conflict of actions, since the Ministry of Health instituted the National Palliative Care Policy ¹¹ in 2024, but 11 states of the federation still had no legislation on this matter.

When qualitatively evaluating these state laws (Chart 2), it is observed that part of them addressed awareness-raising campaigns, inclusion of state palliative care weeks in the official calendar, and production of informative material ¹⁵,¹⁹,²⁴,²⁷,²⁹,³¹,³³. Although such initiatives promote knowledge on the issue and foster the participation of the population, they do not deepen training on the ethical conduct necessary for excellence in care.

It is also worth noting that only two state regulations ¹⁴,¹⁵ included a coercive action in their legal text. This situation leads to reflection on other state laws, whose application may not have practical effects, becoming mere guidelines or recommendations for conduct, instead of full-fledged legal precepts. This premise is supported by the analyses of Pereira and Riveline ¹⁰, who recognize coercion in civil society as a means of limiting the agency of others and ensuring laws that seek to protect the civil rights of citizens.

As for the regulations in university hospitals, it was found that only 37.7% of these units had palliative care regulations. This result deserves consideration, since these hospital organizations are fundamental for health care training and the dissemination of knowledge, with an evident negative impact when only about one third of EBSERH’s 45 hospitals have any provision on the issue. According to Nunes and collaborators ², education on palliative care and its bioethical aspects needs to adopt a theoretical basis (exemplified by the regulations) associated with practical care actions, considering the profile of university students and using the various didactic resources to optimize their understanding. Therefore, the normative gap found has the potential to delay the evolution of bioethical teaching in palliative care in these university hospitals.

In addition, only six regulations of these hospitals ³⁸-⁴³, representing 16.2% of the total, contained some coercive limit or sanction for non-compliance. All regulations with coercive measures were internal regulations of palliative care committees or services, which regulated the organization of these teams and detailed their functioning and competencies ⁴⁸. Possibly because they have regulatory characteristics, these were the regulations that included coercive limits.

In a global analysis of the results, it is observed that only 14% of the current state and federal regulations had coercive mechanisms. This indicates that, in addition to the scarcity of regulations, even those that exist can be ineffective because they do not contain resources that ensure the expected impact. There also arises a reflection on a possible philosophical and conceptual contradiction: would it be coherent to apply coercive mechanisms in regulatory palliative care regulations, which should have wide acceptance and understanding by the population, given that they address personalized health care?

The generalization of the findings of this research can be considered for related areas of clinical palliation, such as the treatment of respiratory symptoms and pain; or even for clinical psychology, since the regulations can be replicated for situations of psychological stress or conflicts between the parties involved in palliative care.

A potential limitation of this study is related to the fragmentation of laws and standards on the issue, in addition to the lack of a single government repository that gathers data in order to optimize their cataloging and interpretation, making it difficult to aggregate information. Another limitation observed was the hindrance to making comparisons between the situation found in federal university hospitals and the situation in private teaching hospitals, as the latter lack a centralized information unit and sometimes do not provide free access to their regulations.

The recommendation for future research considers the possibility of establishing a parallel between the results observed in this study and the situations found in other countries with similar development level or with regional and cultural affinity to Brazilian society.

Final considerations

This study sought to achieve the proposed objectives, identifying the federal and state palliative care regulations and analyzing the coercive limits present in such regulations, emphasizing the importance of biolaw instruments for an ethical practice in palliative care, without disregarding the importance of health care training for the dissemination of this knowledge.

The scarcity of regulations found in this study, combined with the deficient number of coercive resources in the legal texts, shows the urgent need to focus efforts on developing a legal framework suited to palliative care, at risk of delaying the evolution of this treatment mode and compromising bioethics education and application in end-of-life care in Brazil.

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• ¹⁶ Alagoas. Lei nº 8.871, de 16 de junho de 2023. Dispõe sobre a instituição dos preceitos e fundamentos dos cuidados paliativos no Estado de Alagoas. Diário Oficial do Estado de Alagoas [Internet]. Maceió, p. 1-2, 19 jun 2023 [acesso 13 jan 2025]. Disponível: https://bit.ly/3WQv2x2
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• ¹⁷ Amapá. Lei nº 2.812, de 24 de janeiro de 2023. Estabelece a Política Estadual de Cuidados Paliativos no Estado do Amapá. Diário Oficial do Estado do Amapá [Internet]. Macapá, p. 2-3, 24 jan 2023 [acesso 13 jan 2025]. Disponível: https://bit.ly/3Jnglyr
  » https://bit.ly/3Jnglyr
• ¹⁸ Amazonas. Lei nº 6.326, de 27 de julho de 2023. Dispõe sobre princípios e diretrizes para ações voltadas aos cuidados paliativos no âmbito da saúde pública do Estado do Amazonas. Diário Oficial do Estado do Amazonas [Internet]. Manaus, p. 3-4, 27 jul 2023 [acesso 13 jan 2025]. Disponível: https://bit.ly/3WN178X
  » https://bit.ly/3WN178X
• ¹⁹ Amazonas. Lei nº 6.601, de 27 de novembro de 2023. Institui a Campanha de Conscientização sobre Cuidados Paliativos no âmbito do Estado Amazonas. Diário Oficial do Estado do Amazonas [Internet]. Manaus, p. 10-11, 27 nov 2023 [acesso 13 jan 2025]. Disponível: https://bit.ly/3JjKKOd
  » https://bit.ly/3JjKKOd
• ²⁰ Espírito Santo. Decreto nº 5.977, de 26 de fevereiro de 2025. Institui a Política Estadual de Cuidados Paliativos no Sistema Único de Saúde e dá outras providências. Diário Oficial do Espírito Santo [Internet]. Vitória, p. 3-8, 27 fev 2025 [acesso 5 mar 2025]. Disponível: https://bit.ly/3WdbW49
  » https://bit.ly/3WdbW49
• ²¹ Goiás. Lei nº 22.072, de 28 de junho de 2023. Altera a Lei nº 19.723, de 10 de julho de 2017, que institui a Política Estadual de Cuidados Paliativos e altera a Lei nº 16.140, de 02 de outubro de 2007, que dispõe sobre o Sistema Único de Saúde - SUS, as condições para a promoção, proteção e recuperação da saúde, a organização, regulamentação, fiscalização e o controle dos serviços correspondentes e dá outras providências. Diário Oficial do Estado de Goiás [Internet]. Goiânia, p. 6, 28 jun 2023 [acesso 13 jan 2025]. Disponível: https://bit.ly/4nYGXVx
  » https://bit.ly/4nYGXVx
• ²² Maranhão. Lei nº 11.123, de 7 de outubro de 2019. Estabelece as Diretrizes Estaduais para a Implementação de Cuidados Paliativos direcionados aos Pacientes com doenças ameaçadoras à vida, e dá outras providências. Diário Oficial do Estado do Maranhão [Internet]. São Luís, p. 4-5, 7 out 2019 [acesso 13 jan 2025]. Disponível: https://bit.ly/43tsTLq
  » https://bit.ly/43tsTLq
• ²³ Mato Grosso. Lei nº 11.509, de 9 de setembro de 2021. Cria o Programa Estadual de Cuidados Paliativos no âmbito da saúde pública do Estado de Mato Grosso. Diário Oficial de Mato Grosso [Internet]. Cuiabá, p. 2, 10 set 2021 [acesso 14 jan 2025]. Disponível: https://bit.ly/3L2U49G
  » https://bit.ly/3L2U49G
• ²⁴ Mato Grosso do Sul. Lei nº 5.922, de 11 de julho de 2022. Inclui no Calendário Oficial de Eventos do Estado de Mato Grosso do Sul a Semana Estadual de Cuidados Paliativos. Diário Oficial Eletrônico do Mato Grosso do Sul [Internet]. Campo Grande, p. 3-4, 12 jul 2022 [acesso 14 jan 2025]. Disponível: https://bit.ly/4o2hs5X
  » https://bit.ly/4o2hs5X
• ²⁵ Minas Gerais. Lei nº 23.938, de 23 de setembro de 2021. Estabelece princípios, diretrizes e objetivos para as ações do Estado voltadas para os cuidados paliativos no âmbito da saúde pública. Diário Oficial do Estado de Minas Gerais [Internet]. Belo Horizonte, p. 1-2, 24 set 2021 [acesso 14 jan 2025]. Disponível: https://bit.ly/4hrTSNw
  » https://bit.ly/4hrTSNw
• ²⁶ Paraíba. Lei nº 12.651, de 23 de maio de 2023. Estabelece Política Estadual de Cuidados Paliativos no Estado da Paraíba, e dá outras providências. Diário Oficial do Estado da Paraíba [Internet]. João Pessoa, p. 1-2, 24 maio 2023 [acesso 14 jan 2025]. Disponível: https://bit.ly/4hFLIRP
  » https://bit.ly/4hFLIRP
• ²⁷ Paraíba. Lei nº 13.017, de 29 de dezembro de 2023. Institui, no Calendário Oficial de Eventos do Estado da Paraíba, a Semana de Conscientização sobre os Cuidados Paliativos. Diário Oficial do Estado da Paraíba [Internet]. João Pessoa, p. 8, 4 jan 2024 [acesso 14 jan 2025]. Disponível: https://bit.ly/4hiLsrw
  » https://bit.ly/4hiLsrw
• ²⁸ Paraná. Lei nº 20.091, de 19 de dezembro de 2019. Dispõe sobre a instituição dos preceitos e fundamentos dos Cuidados Paliativos no Paraná. Diário Oficial do Estado do Paraná [Internet]. Curitiba, p. 431, 19 dez 2019 [acesso 14 jan 2025]. Disponível: https://tinyurl.com/3njew5af
  » https://tinyurl.com/3njew5af
• ²⁹ Paraná. Lei nº 21.531, de 03 de julho de 2023. Institui a Semana de Conscientização sobre os Cuidados Paliativos a ser celebrada anualmente na segunda semana do mês de outubro. Diário Oficial do Estado do Paraná [Internet]. Curitiba, p. 3, 3 jul 2023 [acesso 14 jan 2025]. Disponível: https://tinyurl.com/mr2kc6u4
  » https://tinyurl.com/mr2kc6u4
• ³⁰ Paraná. Lei nº 21.997, de 4 de junho de 2024. Altera a Lei nº 20.091 de 19 de dezembro de 2019, que dispõe sobre a instituição dos preceitos e fundamentos dos Cuidados Paliativos no Paraná. Diário Oficial do Estado do Paraná [Internet]. Curitiba, p. 6, 4 jun 2024 [acesso 15 jan 2025]. Disponível: https://tinyurl.com/4b6d89cu
  » https://tinyurl.com/4b6d89cu
• ³¹ Pernambuco. Lei nº 16.803, de 27 de dezembro de 2019. Altera a Lei nº 16.241/2017 para incluir o Dia Estadual dos Cuidados Paliativos no Calendário Oficial. Diário Oficial do Estado de Pernambuco [Internet]. Recife, p. 3-4, 28 dez 2019 [acesso 15 jan 2025]. Disponível: https://bit.ly/4hnET7c
  » https://bit.ly/4hnET7c
• ³² Pernambuco. Lei nº 18.014, de 20 de dezembro de 2022. Estabelece a Política Estadual de Cuidados Paliativos, no âmbito do Estado de Pernambuco. Diário Oficial do Estado de Pernambuco [Internet]. Recife, p. 7, 21 dez 2022 [acesso 15 jan 2025]. Disponível: https://bit.ly/4hnETUK
  » https://bit.ly/4hnETUK
• ³³ Pernambuco. Lei nº 18.516, de 16 de abril de 2024. Institui a obrigatoriedade da disponibilização, no sítio eletrônico da Secretaria de Saúde do Estado de Pernambuco, de cartilha ou material informativo sobre Cuidados Paliativos Pediátricos. Diário Oficial do Estado de Pernambuco [Internet]. Recife, p. 8, 17 abr 2024 [acesso 15 jan 2025]. Disponível: https://tinyurl.com/pncwf3sf
  » https://tinyurl.com/pncwf3sf
• ³⁴ Rio de Janeiro. Lei nº 8.425, de 1º de julho de 2019. Cria o Programa Estadual de Cuidados Paliativos no Âmbito da Saúde Pública do Estado do Rio de Janeiro. Diário Oficial do Estado do Rio de Janeiro [Internet]. Rio de Janeiro, p. 1, 2 jul 2019 [acesso 15 jan 2025]. Disponível: https://tinyurl.com/mtfuh7pv
  » https://tinyurl.com/mtfuh7pv
• ³⁵ Rio Grande do Sul. Lei nº 15.277, de 31 de janeiro de 2019. Institui a Política Estadual de Cuidados Paliativos e dá outras providências. Diário Oficial do Estado do Rio Grande do Sul [Internet]. Porto Alegre, p. 6, 31 jan 2019 [acesso 15 jan 2025]. Disponível: https://bit.ly/3L66PjI
  » https://bit.ly/3L66PjI
• ³⁶ Roraima. Lei nº 1.669, de 25 de abril de 2022. Estabelece princípios, diretrizes e objetivos para ações do Estado voltadas para os cuidados paliativos no âmbito da saúde pública do Estado de Roraima - Lei Jeová Melo. Diário Oficial do Estado de Roraima [Internet]. Boa Vista, p. 12-13, 25 abr 2022 [acesso 15 jan 2025]. Disponível: https://tinyurl.com/mt2juyvp
  » https://tinyurl.com/mt2juyvp
• ³⁷ São Paulo. Lei nº 17.292, de 13 de outubro de 2020. Institui a Política Estadual de Cuidados Paliativos e dá outras providências. Diário Oficial do Estado de São Paulo [Internet]. São Paulo, p. 1, 14 out 2020 [acesso 15 jan 2025]. Disponível: https://bit.ly/4nYhHi9
  » https://bit.ly/4nYhHi9
• ³⁸ Universidade Federal da Paraíba. Regimento Interno da Comissão de Cuidados Paliativos do Hospital Universitário Lauro Wanderley [Internet]. João Pessoa: UFPB; 2022.
• ³⁹ Universidade Federal do Tocantins. Regimento Interno da Comissão de Cuidados Paliativos do Hospital de Doenças Tropicais [Internet]. Palmas: UFT; 2022.
• ⁴⁰ Universidade Federal do Rio Grande. Regimento Interno da Comissão Permanente de Cuidados Paliativos do Hospital Universitário Dr. Miguel Riet Corrêa Jr [Internet]. Rio Grande: Furg; 2022.
• ⁴¹ Universidade Federal de Goiás. Regimento da Comissão de Cuidados Paliativos do Hospital das Clínicas [Internet]. Goiânia: UFG; 2022.
• ⁴² Universidade Federal de Campina Grande. Regimento da Comissão de Cuidados Paliativos do Hospital Universitário Alcides Carneiro [Internet]. Campina Grande: UFCG; 2022.
• ⁴³ Universidade Federal do Pará. Regimento Interno do Serviço de Cuidados Paliativos em Oncologia do Hospital Universitário João de Barros Barreto [Internet]. Belém: UFPA; 2022.
• ⁴⁴ Conselho Federal de Medicina. Resolução CFM nº 1.973, de 14 de julho de 2011. Dispõe sobre a nova redação do Anexo II da Resolução CFM nº 1.845/2008, que celebra o convênio de reconhecimento de especialidades médicas firmado entre o CFM, a AMB e a CNRM. Diário Oficial da União [Internet]. Brasília, p. 144-7, 1º ago 2011 [acesso 25 ago 2025]. Seção 1. Disponível: https://sistemas.cfm.org.br/normas/arquivos/resolucoes/BR/2011/1973_2011.pdf
  » https://sistemas.cfm.org.br/normas/arquivos/resolucoes/BR/2011/1973_2011.pdf
• ⁴⁵ Portugal. Lei nº 31, de 18 de julho de 2018. Direitos das pessoas em contexto de doença avançada e fim de vida. Diário da República [Internet]. Lisboa, p. 3238-9, 18 jul 2018 [acesso 20 jan 2025]. Série I. Disponível: https://bit.ly/47zhH2h
  » https://bit.ly/47zhH2h
• ⁴⁶ Argentina. Lei nº 27.678/2022, de 5 de julho. Ley de Cuidados Paliativos. Boletín Nacional [Internet]. Buenos Aires, n. 56041, 21 jul 2022 [acesso 26 ago 2025]. Disponível: https://bit.ly/4qnce6g
  » https://bit.ly/4qnce6g
• ⁴⁷ Colômbia. Lei nº 1733, de 8 de setembro de 2014. Ley Consuelo Devis Saavedra. Diario Oficial [Internet]. Bogotá, n. 49268, 8 set 2014 [acesso 26 ago 2025]. Disponível: https://bit.ly/49dcIFJ
  » https://bit.ly/49dcIFJ
• ⁴⁸ Distrito Federal. Secretaria de Estado de Planejamento e Orçamento. Portaria nº 25, de 24 de fevereiro de 2012. Aprova o Guia para Elaboração de Regimento Interno. Diário Oficial do Distrito Federal [Internet]. Brasília, p. 11-5, 27 fev 2012 [acesso 25 ago 2025]. Seção 1. Disponível: https://tinyurl.com/24ayxkvrwt
  » https://tinyurl.com/24ayxkvrwt

• Data availability:
  All data used or generated in this study are described and presented in full in the body of the article.

Edited by

• Editor in charge:
  Dilza Teresinha Ambrós Ribeiro

Data availability

All data used or generated in this study are described and presented in full in the body of the article.

Publication Dates

• Publication in this collection
  27 Feb 2026
• Date of issue
  2025

History

• Received
  30 Apr 2025
• Reviewed
  26 Aug 2025
• Accepted
  28 Aug 2025