Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T18:12:03.187Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospice and Palliation in the English-Speaking Caribbean

Published online by Cambridge University Press:  27 May 2014

CHERYL COX MACPHERSON ,
NINA CHIOCHANKITMUN  and
MUGE AKPINAR-ELCI
Get access Rights & Permissions [Opens in a new window]

Abstract:

This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients’ unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board (INCB), which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions.

Keywords

Caribbeanpainpalliative careend-of-life caresocioeconomic and cultural conditionsopiatespolicybeneficencehuman rightsprofessionalism
Type
Special Section: Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 23 , Issue 3 , July 2014 , pp. 341 - 348
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Macpherson, C. Undertreating pain violates ethical principles. Journal of Medical Ethics 2009;35:603–6.Google Scholar

2. Teno, J, Connor, SR. Referring a patient and family to high-quality palliative care at the close of life. JAMA 2009;301(6):651–9.CrossRefGoogle ScholarPubMed

3. Zempsky, WT. Treatment of sickle cell pain. JAMA 2009;302(22):2479–80.CrossRefGoogle ScholarPubMed

4. International Narcotics Control Board (INCB). About; available at http://www.incb.org/incb/en/about.html (last accessed 20 June 2013).

5. See note 1, Macpherson 2009, at 603–6.

6. Macpherson, C, Aarons, D. Overcoming barriers to pain relief in the Caribbean. Developing World Bioethics 2009;9(3):99–104.Google Scholar

7. Human Rights Watch Publications. Section VIII. International Human Rights Obligations and Pain Treatment: Health as a Human Right. Global State of Pain Treatment; 2011; available at http://www.hrw.org/node/98902/section/17 (last accessed 20 June 2013).

8. International Association for the Study of Pain (IASP). Declaration of Montreal: Declaration that access to pain relief is a fundamental human right; available at http://www.iasp-pain.org/Content/NavigationMenu/Advocacy/DeclarationofMontr233al/default.htm (last accessed 20 June 2013).

9. Brennan, FB, Carr, DB, Cousins, M. Pain management: A fundamental human right. Pain Medicine 2007;105(1):205–21.Google Scholar

10. Pain and Policy Studies Group (PPSG). Achieving balance in state pain policy; available at http://www.painpolicy.wisc.edu/sites/www.painpolicy.wisc.edu/files/prc2012.pdf (last accessed 20 June 2013).

11. See note 6, Macpherson, Aarons, 2009.

12. Macpherson, CC. Healthcare development requires stakeholder consultation: Palliative care in the Caribbean. Cambridge Quarterly of Healthcare Ethics 2006;15:248–55.CrossRefGoogle ScholarPubMed

13. Kreitzschitz, S, Macpherson, CC. End of life care: Perspectives from families and caregivers. West Indian Medicine Journal 2003;52(4):311–16.Google Scholar

14. See note 12, Macpherson 2006.

15. Caribbean Community (CARICOM); available at http://caricom.org/ (last accessed 25 June 2013).

16. See note 6, Macpherson, Aarons 2009.

17. See note 12, Macpherson 2006.

18. See note 13, Kreitzschitz, Macpherson 2003.

19. See note 6, Macpherson, Aarons 2009.

20. See note 12, Macpherson 2006.

21. See note 13, Kreitzschitz, Macpherson 2003.

22. See note 13, Kreitzschitz, Macpherson 2003.

23. Sepulveda, C, Marlin, A, Yoshida, T, Ullrich, A. Palliative care: The World Health Organization’s global perspective. Journal of Pain and Symptom Management 2002;24(2):91–6.Google Scholar

24. Scholten, W, Nygren-Krug, H, Zucker, HA. The World Health Organization paves the way for action to free people from the shackles of pain. Anesthesia and Analgesia 2007;105(1):1–4.Google Scholar

25. Joranson D, Carrow GM, Ryan KM, Schaefer L, Gilson AM, Good P, et al. Pain management and prescription monitoring. Journal of Pain and Symptom Management 2002;23(3):231–8.

26. International Narcotics Control Board (INCB). Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes; 2010; available at http://www.incb.org/documents/Publications/AnnualReports/AR2010/Supplement-AR10_availability_English.pdf (last accessed 25 June 2013).

27. See note 26, INCB 2010.

28. See note 6, Macpherson, Aarons 2009.

29. See note 12, Macpherson 2006.

30. See note 6, Macpherson, Aarons 2009.

31. See note 12, Macpherson 2006.

32. See note 13, Kreitzschitz, Macpherson 2003.

33. See note 6, Macpherson, Aarons 2009.

34. See note 12, Macpherson 2006.

35. See note 13, Kreitzschitz, Macpherson 2003.

36. See note 6, Macpherson, Aarons 2009.

37. See note 13, Kreitzschitz, Macpherson 2003.

38. See note 6, Macpherson, Aarons 2009.

39. See note 13, Kreitzschitz, Macpherson 2003.

40. See note 1, Macpherson 2009

41. Leon, M, Florez, S, De Lima, L, Ryan, K. Integrating palliative care in public health: The Columbian experience following an International Pain Policy fellowship. Palliative Medicine 2011;25(4):365–9.CrossRefGoogle Scholar