World Medical Association declaration on end-of-life medical care

Preamble:

• It is important to acknowledge the indirect consequences of inadequate pain treatment, (…)
• In most cases, pain can be stopped or relieved with inexpensive and relatively simple treatment interventions, (…)
• It is accepted that some pain is particularly difficult to treat and requires the application of complex techniques by, for example, multidisciplinary teams.
• Lack of education for health professionals in the assessment and treatment of pain and other symptoms, and unnecessarily restrictive government regulations (including limiting access to opioid pain medications) are two major reasons for this treatment gap.
  • Access to controlled medicines

Principles:

• Governments must ensure the adequate availability of controlled medicines, including opioids, for the relief of pain and suffering. Governmental drug control agencies should recognize severe and/or chronic pain as a serious and common health care issue and appropriately balance the need to relieve suffering with the potential for the illegal use of analgesic drugs. Under the right to health, people facing pain have a right to appropriate pain management, including effective medications such as morphine.  Denial of pain treatment violates the right to health and may be medically unethical
• Many countries lack necessary economic, human and logistic resources to provide optimal pain treatment to their population.
• International and national drug control policies should balance the need for adequate availability and accessibility of controlled medicines like morphine and other opioids for the relief of pain and suffering with efforts to prevent the misuse of these controlled substances.
  • Access to controlled medicines

All people have the right to high-quality, scientifically-based, and humane healthcare. Therefore, receiving appropriate end-of-life medical care must not be considered a privilege but a true right, independent of age or any other associated factors.

Palliative care at the end of life is part of good medical care. The need for access to improved quality palliative care is great, especially in resource-poor countries. The objective of palliative care is to achieve the best possible quality of life through appropriate palliation of pain and other distressing physical symptoms, and attention to the social, psychological and spiritual needs of the patient.

1.2 Important advances in the relief of pain and other distressing symptoms have been made. The appropriate use of morphine, new analgesics, and other measures can suppress or relieve pain and other distressing symptoms in the majority of cases. The appropriate health authorities must make necessary medications accessible and available to physicians and their patients.