Principles of Humanitarian Palliative Care
The WHO defines humanitarianism as the benevolent response to the suffering and needs of others. It is action to prevent and alleviate human suffering wherever it may be found, to protect life and health, and to ensure respect for the human being. Motivated typically by charity, solidarity or a sense that one should not remain passive while others are in need, humanitarianism encompasses responses to suffering caused by disaster, conflict, a health emergency or protracted poverty. It often entails providing health care and social supports such as protection, food, water, shelter, sanitation and education.
The following four principles also help to define humanitarianism:
- Humanity: preventing and alleviating human suffering wherever it may be found, protecting life and health, ensuring respect for the human being, promoting mutual understanding, friendship, cooperation and lasting peace among all peoples.
- Impartiality: making no discrimination as to nationality, race, religious beliefs, class, gender or political opinions; endeavoring only to relieve suffering, giving priority to the most urgent cases of distress.
- Neutrality: taking no sides in hostilities or engaging at any time in controversies of a political, racial, religious or ideological nature.
- Independence: maintaining autonomy so as to be able at all times to act in accordance with the principles of humanity, impartiality, and neutrality.
Humanitarianism implies recognition that suffering is universal and requires a response, that suffering cannot be met with indifference. Humanitarianism entails respect for human dignity, helping and protecting others regardless of who they are or what they have done. It involves protecting life and health not only by responding to disaster and disease, but also by preventing them.
Principles of Palliative Care in Humanitarian Emergency or Crises:
People affected by different types of emergencies or crises, such as earthquakes, major storms, hemorrhagic fever epidemics or political violence, may suffer in different ways and require care of different kinds. The principles are:
- Relieve human suffering: The most fundamental goal not only of palliative care, but also of medicine itself, including medicine practiced in humanitarian emergencies and crises, is to relieve human suffering. Saving lives is a crucial way to achieve this goal but not the only way.
- Palliative care and symptom control: Humanitarian responses to emergencies and crises should include palliative care and symptom control. There is an ethical and medical imperative to include palliative care in humanitarian responses.
- “Regards dying as a normal process” and never intends to “postpone death”
In humanitarian emergencies and crises, the statements that palliative care “regards dying as a normal process” and never intends to “postpone death”, as in the 2002 WHO definition, require additional clarification. In this setting, clinicians should provide care aimed at saving life, while also providing appropriate treatment for pain, symptoms and other sources of suffering. Palliative care never intentionally hastens death but provides whatever treatment is necessary to achieve an adequate level of comfort for the patient in the context of the patient’s values.
Palliative care and life-saving treatment should not be regarded as distinct. Palliative care and symptom control should be integrated as much as possible with life-saving treatment for patients with acute life-threatening conditions or triaged red. These tables incorporate recent suggestions from WHO guidelines regarding recommendations for standard triage categories in humanitarian situations.
- Palliative care should commence immediately, as needed, for patients with non-life-threatening conditions (triaged yellow) whose injury- or disease-specific treatment may be delayed.
- Palliative care must be provided for all patients deemed expectant (triaged blue) and should commence immediately.
Table Reference: 1. World Health Organization. Integrating palliative care and symptom relief into responses to humanitarian emergencies and crises: a WHO guide [Internet]. Geneva: World Health Organization; 2018 [cited 2019 Feb 11] p. 107. Available from: https://apps.who.int/iris/bitstream/handle/10665/274565/9789241514460-eng.pdf?sequence=1&isAllowed=y