Palliative Care Declaration

We the Global Palliative Care Community and the Indian Association of Palliative Care call on State Governments, Governmental & Non Governmental Organizations, the donor community, development agencies, the private & public sector companies and the members of the civil society to take immediate steps to slow and ultimately reverse, the growth in deaths from cancer, improve the Palliative Care facilities by committing to the goals, setting the targets and provide resources and political backing for the priority actions needed to achieve them.

Efforts to relieve the symptoms, ease distress, provide comfort, improve the quality of life, relief from pain & other distressing symptoms; relief from anxiety and depression, including the fear of

pain, a sense of security that assistance will be readily available if needed. Poor symptom control, fear and a lack of acceptance of death before dying, can be minimized by ensuring that appropriate medical and social support services are available.

Increase the number of States that simplify the opioid legislation and make pain relief and palliative care an essential service in all the cancer treatment institutions and Government Hospitals along with home-based care, including access to opiods such as oral morphine, symptom control, psychological and family support.

Develop the sustainable delivery systems in place to ensure that effective cancer prevention, early detection, treatment and palliative care service is available to all.

Provide the cancer patients with access to palliative care in all the equipped treatment facilities.

All the cancer patients in pain have access to effective pain control.

Promote the development and use of palliative Care guidelines that are relevant to local needs and resources along with the availability of the well trained staff to meet the needs of patients with cancer. Take steps to tackle the many barriers to optimal pain control. Work with pharmaceutical industry to increase access to palliative care medicines that are affordable and of assured quality.

Intensive education on Palliative Care to the healthcare professionals and it’s inclusion in Nursing, UG and PG Medical Curricula and ensure that the medical care of the dying cancer patient must be effective, humane and compassionate.

Educating the patients, that their pain is treatable at every stage of disease, along with curative treatment. Cancer-related pain profoundly impacts quality of life and is often grossly underestimated and under treated, even when it can be adequately controlled.

Advocacy and Mass sensitization about the need for Palliative Care Freedom from pain should be regarded a Human Right issue.

The Palllatlve Care  Declaration 2011 is developed by Cancer Aid Society for ratification by the 18th International Conference of Indian Association of Palliative Care

Purpose

Cancer leads to a poor quality of life and kills more people than AIDS, TB and Malaria combined, and the need for Palliative Care is set to rise dramatically over coming decades unless concerted action is taken now. In the few years since the start of the 21st century, cancer has already cost almost as many lives as the whole of World War II -the single deadliest conflict the World has ever seen. The global cancer burden is increasing rapidly with growth driven largely by the ageing of the world’s population. By 2030 it is estimated that over 12 million people will die of this disease every year. More than 70% of these deaths will occur in low-and middle-income countries that will require Palliative Care however resources available in the fight against Cancer and Palliative Care are limited or nonexistent in these countries.

Approximately 2/3rd of the World’s new cases of Cancer are in the advanced and incurable stage at the time of diagnosis when only Palliative treatment is possible and as many number of new Cancer patients are expected to be in developing countries with only 5% of Global resources however in sharp contrast with 95% of the resources the developed countries have only 1/3rd of the Cancer burden.

Cancer deprives families, of the caregivers and income earners causing appalling suffering and often economic ruin, as families sink all their resources into paying for the curative treatment(that is often inappropriate and delivered too late)seeking alleviation from agonizing symptoms, due to lack of Palliative Care facilities. Keeping in mind the limited resources available in the developing countries, major emphasis should be given to the Palliative Care.

In absence of Palliative Care patient seeks expensive treatment in Terminal Stages for relief from sufferings which-

+ Breaks down families;

+ Blocks treatable resources;

+ Delays treatment in primary stages;

+ Kills the patients who may be saved;

+ Forming a Vicious Circle.

Under use of opioids condemns millions of cancer patients to suffer unnecessary pain. Access to opioid analgesics is extremely low or non-existent in developing countries. Barriers to access include lack of knowledge, training and skills in pain management, negative public attitudes, economic constraints and regulatory impediments.

Patients with cancer that cannot be cured, can be given palliative care to minimize their sufferings and help them to die with dignity creating the need for this thought for us:

Even the hardcore criminals who are sentenced to death are asked for their last wish which is fulfilled and they are given a painless death. It is indeed very unfortunate that in our country the patients who get a death warrant by Cancer suffer for months together in excruciating pain cursing themselves for none of the sins they have committed. Should they not be given freedom from acute pain as they pray for an early death to get rid of the pain.

Yes they can ! says WHO, by giving Oral Morphine.

Then why do they suffer despite India being one of the largest producer of Morphine in the World.

In order to make it easier for cancer patients to gain assess to the medication they need to control their pain, some State Governments have simplified legislation or policies governing opioid availability, however still availability of Oral Morphine even in the Government Hospitals is lacking in those States.

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