“Who is carrying the placard for morphine for palliation at the end-of-life?”…Sir George Alleyne

Sir George is quite a guy. From Barbados, he is Director Emeritus of the Pan America Health Organization (PAHO) having been its director from 1995-2004. He has served the UN Secretary-General’s Special Envoy for HIV/AIDs in the Carribean since 2003. He is a physician and former Chair of the Dept of Medicine at the University of the West Indes.

I first heard his spirited tones when he was panel member for the Non Communicable Disease Alliance event at the World Health Assembly in May.  This question was posed to the panel.

“From what diseases will women be allowed to die?”

“I am not going to answer that question,” Sir George stated, the only one with what seemed to be the courage to answer it, “because I will have to answer to my wife as why I am saying that  women should be allowed to die!! (yes he got a good laugh).  But rather than answer the question, let me tell you from what women should NOT be allowed die. Women should NOT be allow to die of  conditions that we can prevent and for which we can screen, such as the complications of childbirth, domestic abuse, sexually transmitted diseases and the conditions associated with these, like cancer of the cervix and detectable breast cancers, and diseases associated with tobacco use.”

I thought an astute answer that addressed the fact that death can be delayed but is not preventable! I was impressed.

Well Sir George was asked to give the closing comments at the recent UN Civil Society Informal Forum on Non Communicable Diseases.

This was an interesting meeting at UN HQ in New York. Of the 6 hours, 1 hour was committed to UN formalities (opening and closing ceremonies). We were in the General Assembly Hall but sort of as visitors (We were not allowed into the UN cafeteria).  There was over 300+ organizations attending but too many of the “prepared talks” went way over time (15 rather than 5 minutes). As much as the chair tried to have people respect time and to stimulate discussion, most of the annointed ones seemed very reluctant to move away from what they had prepared.  Don’t get me wrong. I think alot was achieved and this was an essential part of the preparation of a document that will be presented at the UN Leader’s summit in September this year. But I am told this lacked the fire and passion one sees with similar forums related to HIV/AIDS.

Sir George gave an excellent summary of the day, and he captured a sense of what those of us from the palliative care field had thought about the day. Yes Cary Adams from UICC and the Ambassabor of Keyna had mentioned palliative care but Sir George raised three neglected areas.  I will mention one.

“Who is carrying the placard for morphine for palliation at the end-of-life?”

There are many who are holding the placard but it seems that either we are not enough of us or we are not making enough noise!  Perhaps we cannot measure the cost of pain at the end of life as a burden on the world’s economies.

Or perhaps the world doesn’t care.

This I don’t believe because this is a personal issue for most of us when faced with a cancer diagnosis.  But it does not seem to have made the priority list of our global and governmental leaders.

Sir George, we at the Pain and Policy Studies Group have been carrying this placard for global access to morphine since the late 1980 and then with recognition of this work in 1996 when PAHO and the WHO appointed us as a Collaborating Center for Pain Policy. Many others have participated in this effort to ensure access to opioids, medications that the Single Convention on Narcotic Drugs and the WHO defines as essential medicines.

I have started to list some of these, with a growing number linked as both a future resource and as an answer to Sir George’s question. Please add your name and/or link to the comments below.  And perhaps I need to answer Sir George and ask for his help in bringing this important issue to a much higher position on the agenda of the September UN Summit on Non Communicable Diseases.

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International

• International Association for the Study of Pain
• International Association for Hospice and Palliative Care
• Worldwide Palliative Care Alliance
• Union for International Cancer Control (UICC) and its Global Access to Pain Relief Initiative (GAPRI) and Treat the Pain program.
• Human Rights Watch
• International Network for Cancer Treatment and Research
• NCD Alliance

Regional Palliative Care/Cancer Organizations

• European Association for Palliative Care
• African Palliative Care Association
• Asian Pacific Palliative Care Network
• Latin American Palliative Care
• European Society of Medical Oncology
• American Society of Clinical Oncology.