Volume 23, Number 5: May 2022
How Climate Friendly is Palliative Care?
By Katherine I. Pettus, PhD
IAHPC Senior Advocacy and Partnerships Director
On Earth Day in April, I reflected on whether palliative care was climate friendly and how it compares with alternatives. The Report of the Lancet Commission on the Value of Death claims that, “Climate change, the COVID-19 pandemic, environmental destruction, and attitudes to death in high-income countries have similar roots—our delusion that we are in control of, and not part of, nature.” Might the roots of palliative care be less delusional?
Many governments now require their policymakers to evaluate all proposed laws through gender and climate lenses. To evaluate end-of-life care through a climate lens, and to make informed decisions, lawmakers will need studies on the comparative climate impacts of euthanasia, community-provided palliative care, intensive care, and abandonment. How are euthanasia poisons, medical waste in general, or palliative care medicines in particular sourced, manufactured, and disposed of? What are the comparative climate costs? Many home care teams have unsustainable transportation costs that should be confronted. Teams waste hours in traffic jams in Bogotá, Manila, and Nairobi, often failing to reach the patients who need care.
“Pollution from the health sector can take many forms. Hospitals and pharmaceutical companies are the largest drivers of emissions,” according to a PLOS Medicine study.1 The authors also pointed to the impact of medical waste, use of unsustainable materials, and the anesthetics used in surgery, which are greenhouse gases. An upcoming module of the IAHPC Advocacy Course will address how to advocate for palliative care as a “green” option for the 21st century.
The CUDECA Institute
Our delusion that we are in control of nature, as the Lancet commission on death claims, comes at a price. Legalizing euthanasia and medical assistance in dying perpetuate the delusion. That was the subject of a lecture I attended by Professor Federico de Montalvo Jääskeläinen at the University of Málaga, titled “Sesión académica sobre los retos éticos que plantea la ley orgánica de Regulación de la Eutanasia” [Academic session on the ethical challenges posed by the organic law regulating euthanasia]. I had been invited by Dr. Rafael Gómez García and María Jesús De La Ossa Sendra, senior medical staff at CUDECA, the one and only freestanding hospice in Spain, on the Costa del Sol.
Founded by the late Joan Hunt, CUDECA has the new Yusef and Farida Ahmied Institute, which aims to train an entire generation of palliative care providers from all over the world. Institute Director Ángel Bataller will contribute a guest column to next month’s newsletter describing the institute and its programs in detail. The Yusef and Farida Ahmied Foundation also subsidizes a similar hospice and palliative care training center in Pune, India. By providing antiretroviral therapy at a fraction of the cost demanded by western pharmaceutical companies, Yusef Ahmied’s pharmaceutical company, CIPLA, made treatment affordable for HIV-positive people in low- and middle-income countries, particularly in Africa and Asia.
While in Málaga, I rode along with Dr. Naomi and Nurse Elisa’s home care team and had the privilege of sitting with several patients (as well as their family members) in various stages of serious illness. The pandemic made this sort of proximity, which drives my advocacy work, impossible for several years.
High-level webinar on opioid governance
The IAHPC, with the Vienna NGO Committee on Drugs and the United Nations Office of Drugs and Crime (UNDOC), cohosted a high-level webinar titled “Protecting public health and welfare through balanced opioid governance.” His Excellency Ambassador Ghislain D’Hoop (Belgium), president of the Commission on Narcotic Drugs 2022, moderated the expert panel that included Felicia Knaul, Chair of the Lancet Commission on Palliative Care and Pain Relief; Keith Humphreys, Chair of the Stanford Lancet Commission on the North American Opioid Crisis; Dr. M.R. Rajagopal from India; and Maria-Goretti Ane Logo, a human rights lawyer from Ghana. UN Secretariat representatives from the World Health Organization (WHO), UNDOC, and the International Narcotics Control Board commented on the recommendations of the academics and civil society advocates.
Key takeaways:
- The dramatic inequity in access to and availability of controlled medicines persists, despite decades of work, but awareness of the problem is growing.
- Balanced opioid governance and avoiding public health harms of nonmedical use requires exposing the illegal tactics of industry regarding opioid marketing and profit seeking, and taking the profit motive out of sales of opioid sales by distributing generic morphine.
- Suffering must be made visible. “There is no such thing as the voiceless, only the deliberately silenced or preferably unheard,” said Dr. Rajagopal, quoting author Arundhati Roy.
- Convene multi-stakeholder consultation groups for member states on availability of pain medicines, including civil society and affected populations.
- Restrictive drug policies harm the rural poor, who need controlled medicines for pain management, treatment of substance use disorder, and palliative care.
View the recording and stay tuned for my detailed report on the event, which will be available in late May.
75th World Health Assembly
IAHPC Advocacy Focal Points are busy preparing their governments for the 75th World Health Assembly (WHA) at the end of May, urging delegations to ensure that palliative care is included in any treaty, convention, or high-level declaration on pandemic preparedness and response. I have been participating in the WHO consultations with member states and representatives of global health civil society organizations. It is important that pressure comes from governments as well as civil society, as the official voice always carries more weight with member states, as those who have taken the IAHPC Advocacy Course know. WHA75 will be in person in Geneva; look for my report next month.
Speaking of the Advocacy Course…
Module 5 of the online IAHPC Advocacy Course, released in April, concerns the ethics of palliative care advocacy, which I describe as biomedical ethics writ large, focusing particularly on justice and beneficence. Module 6, to be released in late June, will address how to collect evidence and write a policy brief to present to your governments as you prepare them for the multilateral meetings of the WHA, the Commission on Narcotic Drugs, and the Open-Ended Working Group on Ageing. Advocacy always relies on evidence and stories. Fortunately, the data is being published now, and we must use it to educate policymakers and the media.
Reference
- Mercer C. How Health Care Contributes to Climate Change. CMAJ 2019; 191(14): E403-04.
DOI: 10.1503/cmaj.109-5722
To learn more about the CUDECA Institute visit the IAHPC Global Directory of Palliative Care Institutions and Organizations.