Suffering Normal for Most

[Abu-Salman]

Access to pain treatment a luxury for most

 

Original TextJoseph Amon a, Diederik Lohman a, Laura Thomas a

 

 

Guy Micco and colleagues (Sept 12, p 872)1 are right to emphasise that, whenever possible, patients near the end of their lives must be free to choose whether their care includes optimum pain relief, or more limited use of opioids with the aim of promoting consciousness and lucidity. However, for most patients worldwide, there is no such choice.

 

WHO estimates that each year 5·5 million patients with terminal cancer and 1 million with end-stage HIV/AIDS die without access to adequate pain treatment.2 According to Sevil Atasoy, President of the International Narcotics Control Board, access to morphine is “virtually non-existent in 150 countries”.3

 

When Human Rights Watch spoke to people who had lived with untreated severe pain,4 they expressed sentiments similar to those of torture survivors: all they wanted was for the pain to stop.

 

Several people told us that they had wanted to commit suicide, had told doctors or friends that they wanted to die, or had prayed for death.

 

We found that barriers to pain treatment access included inadequate education for health professionals, doctors' fear of prescribing opioid medications, inadequate supply and distribution systems, and unnecessarily restrictive regulation—for example, in Ukraine three doctors must sign any opioid prescription.

 

Many of these barriers could be removed through cost-neutral or low-cost reforms.4

The desire to die with dignity, according to one's own concept of a “good” death, is universal. Governments should work to ensure access to pain treatment, not as a luxury of the wealthiest nations, but in realisation of a universal human right.

 

We declare that we have no conflicts of interest.