The global palliative care community, following the lead of the European Association for Palliative Care and PallCHASE, is deeply concerned about the situation in Ukraine and its devastating impacts on communities, families, children, and those with serious pre-existing medical conditions. PallCHASE issued a statement on March 1 that you can read here.
Armed conflicts have devastating consequences for vulnerable populations. We are gravely concerned about the lack of critical medical equipment, supplies, and essential medications to address the needs of vulnerable persons affected by the conflict, in particular children living with pre-existing medical conditions, older persons, and people living with cancer, HIV, TB, and other communicable and noncommunicable diseases. The impact is felt by patients in Ukraine, as well as patients in Russia who will find it difficult to access palliative care as a consequence of sanctions and economic hardships. Resource reallocation during acts of war affect everyone—including those who work in emergency services, intensive care units, and in palliative care. We express our solidarity with the brave health care workers and palliative care providers who are working tirelessly under great threat and challenging conditions to safeguard human life in times of armed conflicts across the globe.
Just as palliative care clinicians reject the adage that “nothing more can be done,” we know that much can always be done to comfort and support patients and their families. We express our support for all efforts leading to a quick and peaceful resolution of conflicts, so that we can continue to advance palliative care integration in all countries and regions of the world.
On another sad note, as many of you are probably aware, Dr. Cynthia Goh passed away last month. Dr. Goh was a pioneer and amazing force in the development of palliative care and hospice care in the Asia Pacific region. She will be greatly missed by the global palliative care community. This issue of the newsletter includes a tribute to Dr. Goh’s work and her amazing achievements that led to better policies and the inclusion of palliative care in medical curricula. We are deeply grateful for her contributions and for her commitment to good quality care.
Finally, on another important topic, there have been new reports and articles about physician-assisted suicide (PAS) and euthanasia, so we would like to highlight some relevant issues in this message. Recent years have seen the growing acceptance of both, including Australia, Austria, Canada, England and Wales, Spain, and the United States; and the Senate in Chile is discussing a draft legislation on the topic. Many have argued that both euthanasia and PAS prevent suicides among persons facing end of life with serious health-related suffering. However, a study published in February in the Journal of Ethics in Mental Health1 shows that the opposite is true: suicide rates [non-assisted] have not declined where the practice is legal, relative to countries where it is not. And there are statistically significant increases in suicides (including assisted suicide) and in intentional self-initiated death, especially among women, in countries where either euthanasia or PAS or both are approved.
Sovereignty means that countries are free to choose their own laws. IAHPC's position is that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to appropriate medications, including opioids for pain and dyspnea. IAHPC believes that palliative care providers in states and countries where euthanasia and PAS are legal should not be responsible for overseeing or administering these practices, as doing so could place the professionals, their staff, and—in some cases—patients and their families, in untenable positions. Health professionals and institutions should have the legal right to conscientious objection and not suffer drastic consequences if they refuse to provide services that they consider involves the intentional killing of a human being. Take a moment to read the IAHPC Statement on Euthanasia and Physician-Assisted Suicide to learn more about this topic.
Until next month,
Lukas and Liliana
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