Pain and Ethics – Pre-conference workshops for the South African Palliative Care Conference

The pre- conference workshops for the South African Palliative Care Conference got underway on Wednesday 26^thApril in Cape Town. Six workshops were held, three in the morning and three in afternoon organised by PALPRAC, PatchSA and the Hospice and Palliative Care Association of South Africa.

In the morning the paediatric workshop focused on managing children’s total pain and distressing symptoms through whole-person care. This interdisciplinary workshop, attended by around over  participants, was moderated by PatchSA and Dr Michelle Meiring and facilitated by Dr Justin Baker and PatchSA members from across South Africa. It was a case-based exploration of complex pain in a 12 year old boy experiencing phantom limb pain following an amputation for Osteosarcoma. During the workshop participants explored all aspects of his total pain including physical, psychological, social, spiritual and cultural.  Both pharmacological and non-pharmacological treatments were addressed by a multi-disciplinary team including palliative care paediatricians, nurses, allied health care practitioners, psycho-social professionals and integrative therapists. Participants left with a comprehensive pain management plan and an approach to help them manage similar challenging cases in practice. Concepts discussed and explored included – relationship-based care, love, therapeutic alliance, spiritual care and existential distress, dignity and autonomy, anticipatory guidance, family care, community-based care and home-based care, etc.

In the afternoon the focus moved to the law, ethics, and shared decision-making in children’s palliative care. It was attended by 40 participants from a range of settings, working with neonates, children and adolescents, and across a variety of disciplines including doctors, clinical officers, nurses, counsellor, social workers, researchers and journalists. Organised by PatchSA it was chaired by Prof Julia Downing from the International Children’s Palliative Care Network (ICPCN) with facilitators Dr Michelle Meiring, Dr Lyndal Gibbs and Lucy Jamieson. The workshop explored the ethical issues raised by the case of a young 6-year old girl called Caitlyn, and the ethical issues raised in her care and the process of decision making. Following a discussion of some of the principles of the legal and ethical issues and shared decision-making, participants were split into two groups and asked to prepare for a debate taking opposing sides with regards to the decisions that needed to be made re Caitlyns care and the opposing views of her mother and grandmother. A lively debate and discussion followed exploring some of the key issues, recognising the complexities in the provision of care, family dynamics, legal constraints and the part that our emotions play in decision making.

The children’s workshops were lively and thought provoking and it was exciting to be able to meet together again and discuss some of the important issues. Following the workshops participants attended the conference cocktail event with the conference chairs – Dr Margie Venter and Dr Julia Ambler welcomed participants and Tracy Winde giving the welcoming address. There was a great sense of anticipation of what is in store for the conference over the coming days.