Palliative care services are under-resourced at the best of times. The 2017 Lancet
Commission on Palliative Care and Pain Relief described the widespread lack of access
to inexpensive and effective interventions as a travesty of justice. And these are
not the best of times. As health systems become strained under COVID-19, providing
safe and effective palliative care, including end-of-life care, becomes especially
vital and especially difficult.
Some doctors, short of resources, might have to decide who can receive critical care
and who cannot. For patients who won't survive, high-quality palliative care needs
to be provided at least. But COVID-19 makes this more difficult. Time is short when
patients deteriorate quickly, health professionals are overworked, isolation is mandated,
and families are advised not to touch or even be in the same room as loved ones. This
scenario will be compounded most in low-income and middle-income countries where shortages
of both critical care and palliative care services are greatest. Continuing community-based
palliative care is also harder to do safely. Many patients who need it are at heightened
risk from COVID-19, protective equipment is running short, and surging deaths could
overwhelm usual service provision.
WHO has issued guidance on how to maintain essential health services during the pandemic,
highlighting immunisation, maternal care, emergency care, and chronic diseases among
others, but there was no mention of palliative care. This was an oversight. Indeed,
palliative care ought to be an explicit part of national and international response
plans for COVID-19. Practical steps can be taken: ensure access to drugs (such as
opioids) and protective equipment, consider a greater use of telemedicine and video,
discuss advance care plans, provide better training and preparation across the health
workforce, and embrace the role of lay carers and the wider community.
A pandemic is a cause and powerful amplifier of suffering, through physical illness
and death, through stresses and anxieties, and through financial and social instability.
Alleviation of that suffering, in all its forms, needs to be a key part of the response.
© 2020 Fabrizio Villa/Getty Images
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