Details

Autor(en) / Beteiligte

• Rosa, William E
• Grant, Liz
• Knaul, Felicia Marie
• Marston, Joan
• Arreola-Ornelas, Hector
• Riga, Olena
• Marabyan, Roman
• Penkov, Andriy
• Sallnow, Libby
• Rajagopal, M R

Titel

The value of alleviating suffering and dignifying death in war and humanitarian crises

Ist Teil von

• The Lancet (British edition), 2022-04, Vol.399 (10334), p.1447-1450

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2022

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• The Lancet Commission on the Value of Death12 challenged the medicalisation of dying and death and reaffirmed the moral injustice of the global palliative care and pain relief divide.13 The devastating humanitarian crisis in Ukraine raises the vital importance of these issues.12,13 Between 2014 and 2021, the long-term Russian–Ukrainian armed conflict led to more than 50 000 Ukrainian casualties and since Feb 24, 2022 more than 3 million Ukrainian residents have been displaced.14 In Ukraine, attending to the seriously ill and dying is complicated by the trauma and instability of war,11,12 as well as the unfolding COVID-19 pandemic in a country with low vaccination coverage.15 Organisations such as the Palliative Care in Humanitarian Aid Situations and Emergencies (PallCHASE) have called for multisectoral global leaders and governments to ensure timely measures are enacted to maintain human dignity for those with serious health-related suffering during the conflict.16 Global health stakeholders cannot remain silent about the value of life, death, and the alleviation of suffering in the face of humanitarian crises occurring worldwide, most receiving less press coverage than Ukraine. Access to opioid analgesics for surgery and pain and symptom management is among the most limited in Europe, substantially curtailed by opiophobic regulations.13,26 In 2015, Ukraine had roughly 120 mg of distributed opioid morphine-equivalent (DOME) annually per patient with serious health-related suffering, satisfying only 7% of the country's national palliative care need.13 Ukraine's DOME is estimated to satisfy less than 1% of all medical needs (including surgery and trauma) when compared with the average requirements among 19 western Europe countries.13 In the current conflict, the increase in requirements for pain relief medicines for war-related injuries is an emergency, given previous insufficient stock and access to opioid analgesics. Sparsely available controlled essential medicines must be prioritised based on triaged need in alignment with crisis standards of care;5,6,10 regulations or actors that delay provision of pain and symptom relief must be held to account.16 The International Narcotics Control Board has emphasised that during humanitarian crises: protocols may be simplified for the export, transport, and provision of controlled medicines; appropriate national authorities can permit export of controlled medicines (eg, opioids, psychotropic substances) to areas in need without import authorisation or medicine estimates; and receiving countries do not need to include urgent shipments of controlled medicines in their estimates.27 Armed conflict and war are social determinants of death, dying, and grief.