“But also live until you die”: Exploring Palliative Care in the Global Health Context

On October 24th, students and faculty from the Global Health Department had the opportunity to deepen their understanding of palliative care in a global health context through both a seminar and a workshop. These events were facilitated and funded by BIRMAC, a Birmingham University and McMaster University partnership geared towards advancing both institutions’ shared academic values with contributions by Dr. Ping Guo, Dr. Nikolaos Efstathiou, Dr. Sonya de Laat, Rachel Yantzi, and Dr. Lisa Schwartz. M.Sc. students Ogo Ikenga and Laura Plens Shecaira shared their reflections on these impactful events.

Ogo’s Reflections on The Seminar 

“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” – Dame Cicely Saunders

These famous words of Dame Cicely Saunders, the founder of modern palliative care, were echoed by our visiting professors from Birmingham University, Ping Guo and Nikolaos Efstathiou, during a recent guest lecture. Their talk, titled “Palliative and End-of-Life Care: Setting and Managing Priorities From a Global Health Perspective” emphasized the importance of adopting a global approach to palliative care,  especially when addressing the needs of vulnerable and marginalized groups.

Throughout the lecture, Efstathiou helped to broaden attendees’ understanding of the general concept of palliative care and its relationship to the global health context. He stressed the need to align palliative care initiatives with the unique needs of the community in order to support equity and inclusion at all times. To illustrate the significance of community-centered and equity-focused care, Guo discussed the unique challenges of providing palliative care to people who are displaced by conflict and who may be close to the end of their lives, especially refugees. She also introduced the Integrated Palliative care Outcomes Scale (IPOS), a valuable tool used to proactively screen patients who may need palliative care.

This lecture deepened my understanding and appreciation of how essential intersectionality is when addressing global health challenges. By considering the unique needs of vulnerable populations who are often underrepresented in decision-making, we can work toward a more inclusive healthcare approach- one where each individual is holistically supported from their first to last breath.

Laura’s Reflections on the Workshop

As humanitarian crises intensify worldwide, listening to experts express their commitment to ‘do no harm’ offers us a glimmer of hope. In this interactive workshop, we explored the ethical intricacies of providing palliative care in complex humanitarian settings.

Complex humanitarian emergencies arise when multiple crises intersect, creating a challenging environment where delivering care is imperative but fraught with obstacles. Lisa Schwartz, the Arnold L. Johnson Chair in Health Care Ethics, opened the workshop with a thought-provoking question: “While humanitarian aid efforts focus on saving lives, what happens to those whose lives cannot be saved?”

Guided by Pin Guo, Nikolaos Efstathiou, Sonya de Laat, Rachel Yantzi, and Lisa Schwartz, we delved into the cultural and ethical considerations of palliative care in challenging settings where resources, including medical personnel, are often scarce. Participants with diverse experiences shared their insights and stories, greatly enriching the discussion.

According to the World Health Organization, “palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.” Under this definition, a palliative care approach must extend beyond the treatment of physical symptoms and view the individual and their families as a whole.

Thus, it is essential to understand the priorities of patients and their families. In humanitarian settings, alleviating suffering might look like bringing water to the tent of a cancer patient or holding a patient’s hand in their final moments.

Throughout the discussions and scenarios presented, cultural awareness and compassion emerged as central themes. While ethical considerations in humanitarian settings are often complex, we learned that palliative care is about more than “doing no harm”: it is about supporting the patient until the last moment of their lives. Pin Guo concluded the workshop with a powerful quote from Dame Cicely Saunders: “(…) We will do all we can not only to help you die peacefully, but also live until you die.” This not only gave us hope but also inspired meaningful action, in academia and beyond.