Imagine if you were suffering with terminal pancreatic cancer and in excruciating pain around the clock and your doctor was not allowed or unwilling to give you any morphine or other opioid to relieve your pain. In this country, we take it for granted that in most hospitals, our pain would be eased through drugs and the hospital may even provide someone to ease the emotional and spiritual pain of dying as well. In much of the world, including sometimes in the U.S., this is not the case. Patients suffer agonizing pain, whether it is cancer or some other condition because pain medications are illegal, or state regulations limit the amount that can be prescribed, or there are religious restrictions.
Now there may be some good news on the horizon. Recently the executive board of the World Health Organization (WHO) passed its first resolution dealing exclusively with palliative care called "strengthening of palliative care as a component of integrated treatment within the continuum of care." Okay, what does that mean exactly? It means that WHO, the public health arm of the United Nations, is urging its 193 members to adapt palliative care measures in their health care systems. Palliative care is the treatment of physical and spiritual distress. The U.S. along with 193 other countries and territories make up WHO.
For example, in Ukraine, which is in the news on other issues lately, the government set the dose that cancer patients with pain could receive at 50 mg of injectable morphine a day. However, the evidence is that opioid responsiveness varies among patients, and no one size fits all. Human Rights Watch wrote a lengthy report on the situation in Ukraine. They interviewed physicians throughout the country and showed how these draconian policies interfere with patient access to pain relief. And the physicians face an ethical dilemma as well, whether to remain loyal to the government or to their patients.
In most states in India medical professionals continue to hold a centuries old belief that all opioids are addictive and so they restrict such pain medications even for those patients with terminal illness. It is hard to understand why they would worry about someone who is about to die becoming a drug addict. Unfortunately, the same belief is still present in the U.S.
I greatly admire the life's work of neurologist Dr. Kathleen Foley who has helped make managing cancer pain a normal part of any treatment at Memorial Sloan-Kettering Cancer Center in New York and has worked to promote pain relief and palliative care around the world. She is medical director of the Open Society Foundations' International Palliative Care Initiative, a philanthropic effort to advance palliative care in resource-limited settings. Her work has helped make WHO aware of the importance of palliative care.
The WHO General Assembly still needs to accept this resolution at its meeting in May, and I urge everyone to support its passage by sharing this article with others.
Every day my professional chaplain colleagues at HealthCare Chaplaincy Network help people faced with the distress of illness and suffering to find comfort and meaning as members of the palliative care teams at hospitals. Palliative care is a human right, a basic value of human culture. We may not be able to save everyone's life, but we certainly can ease their pain.
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