Palliative care in the pandemic: Have human rights been preferential?
Keywords:COVID-19, Ethics, Human rights, Palliative care, Pandemic, Public health
The skills that palliative care teams use every day at the bedside â€“ symptom management, compassionate care, counselling of patients and families, calm and professional demeanour â€“ are the same skills needed to treat patients with COVID-19. When it comes to humanitarian crises, the World Health Organization lists seven ethical principles that should direct palliative care. Unfortunately, many of these have been rendered impractical due to resource limitations and lack of training. Moreover, these ethical principles may guide individual patient encounters, but fall short when dealing with moral conflicts arising at a community or population level. We discuss how awareness of human rights can guide situations that call for tough decision-making in wake of this pandemic, and help us address some of these conflicts.
The WHO: Palliative Care. Geneva: World Health Organization. [cited 2021 Feb 12]. Available from: https://www.who.int/cancer/palliative/definition/en/
Wynne KJ, Petrova M, Coghlan R. Dying individuals and suffering populations: applying a population-level bioethics lens to palliative care in humanitarian contexts: before, during and after the COVID-19 pandemic. J Med Ethics. 2020;46(8):514-25.
Vallath N, Tandon T, Pastrana T, Lohman D, Husain SA, Cleary J, Ramanath G, Rajagopal MR. Civil society-driven drug policy reform for health and human welfare - India. J Pain Symptom Manage. 2017;53(3):518-32. Available from https://www.doi.org/10.1016/j.jpainsymman.2016.10.362.
Salins NS, Pai SG, Vidyasagar M, Sobhana M. Ethics and medico-legal aspects of â€œNot for Resuscitationâ€. Ind J Palliat Care. 2010;16:66-9.
Rao JM. Law commission of India. 196th report on medical treatment to terminally ill patients (protection of patients and medical practitioners). 2006 Mar [cited 2021 Feb 12]. Available from www.lawcommissionofindia.nic.in/reports/rep196.pdf.
WHO: Palliative Care. Key Facts. Geneva: World Health Organization. 2020 Aug 05 [cited 2020 Sep 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care
United Nations Committee on Economic, Social and Cultural Rights. General Comment No. 14: The right to the highest attainable standard of health. Office of the High Commissioner of Human Rights. Contained in Document E/C.12/200/4/11. 2000 Aug 11 [cited 2021 Feb 12]. Available from http://www.refworld.org/pdfid/4538838d0.pdf
World Health Organization. Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide. Geneva: World Health Organization. 2018 [cited 2021 Feb 12]. Available from https://apps.who.int/iris/handle/10665/274565.
Evans M, Walker J. Hospitals are rationing Remdesivir. The Wall Street Journal. 2020 May 22 [cited 2021 Feb 12]. Available from https://www.wsj.com/articles/location-plays-big-role-in-patient-access-to-first-covid-19-drug-11590157424
Truog RD, Mitchell C, Daley GQ. The toughest triage - allocating ventilators in a pandemic. N Engl J Med. 2020;382(21):1973-75. Available from https://www.doi.org/10.1056/NEJMp2005689.
Arya A, Buchman S, Gagnon B, Downar J. Pandemic palliative care: beyond ventilators and saving lives. CMAJ. 2020;192(15):E400.
Wikler D, Brock DW. Population-level bioethics : mapping a new agenda. In: Green RM, Donovan A & Jauss SA (eds.). Global Bioethics: Issues of Conscience for the Twenty-First Century. Oxford: Oxford University Press. 2008 Dec 27. pp 368.
Childress JF, Faden RR, Gaare RD, Gostin LO, Kahn J, Bonnie RJ, Kass NE, Mastroianni AC, Moreno JD, Nieburg P. Public health ethics: mapping the terrain. J Law Med Ethics. 2002;30(2):170-8. Available from https://www.doi.org/10.1111/j.1748-720x.2002.tb00384.x.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-36. Available from https://www.doi.org/10.1126/science.847460
Evans L, Trotter DR. Epistemology and uncertainty in primary care: an exploratory study. Fam Med. 2009;41(5):319-26
European Network of National Human Rights Institutions. Human Rights-Based Approach. Brussels, Belgium: ENNHRI. [cited 2021 Feb 12]. Available from http://ennhri.org/about-nhris/human-rights-based-approach/
The British Medical Association. Advice and Support: COVID-19: ethical issues when demand for life-saving treatment is at capacity. London: BMA. [cited 2021 Feb 12]. Available from https://www.bma.org.uk/advice-and-support/covid-19/ethics/covid-19-ethical-issues
Kolbe L. Coronavirus has given doctors a new job: palliative care. The Washington Post. 2020 Apr 23 [cited 2021 Feb 12]. Available from https://www.washingtonpost.com/
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Copyright (c) 2021 Vinayak Jain, Omer Mohammed Mujahid, Dr Pragna Rao
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