The death toll from the COVID-19 pandemic has exposed the public to the reality of death and dying, raising awareness of the fragility of one’s mortality. It has revealed to many care professionals and policymakers the need for integrated, comprehensive care provision across public health and medical services, including palliative and end-of-life care. With large disparities in the capacity of health systems globally prior to the pandemic, inequity in the response to COVID-19-related palliative care needs was inevitable across low-income, middle-income and high-income countries (HICs). Importantly, the immediacy of the dialogue around COVID-19 response preparedness has largely muted calls around the need to enhance palliative care service provision in low-income and middle-income countries (LMICs), and the longer term development necessary to inform future disease outbreaks specifically and the needs of the dying generally.
COVID-19 – Dhaka
Photo courtesy of Maruf Rahman
Palliative care (PC) was initially deprioritised in the contagion compared with efforts aimed at curbing the infection, medical management and vaccine development. However, escalating admissions to HICs intensive care units increased awareness of the prevalence of patient symptoms that can be highly distressing, including breathlessness, pain and delirium. They also highlighted the often poor quality of dying and death of those affected by COVID-19, and the grieving needs of bereaved families and friends, colleagues and communities, challenging the feasibility of individualistic Western conceptions of a ‘good death’.1
Recognition of the importance of PC accordingly grew, clinical narratives emphasised the integration of care and relief for those destined not to survive, as well as saving those who could. Subsequent guidance has been provided internationally to governments to ensure continued access to controlled medicines, including opioids, during the pandemic,2 alongside the need to integrate palliative care in response preparedness plans.3 The COVID-19 response in HICs reinforced the vital contribution PC can make in addressing the multidimensional needs of patients with advanced disease—for example, controlling their symptoms, augmenting their quality of life, assisting with complex decision-making and providing holistic care of physical, psychological, social and spiritual pain—shifting resources to communities, and ensuring some dignity in the dying process. For families and caregivers, too, palliating challenging bereavement grief in the short-term, and prolonged, problematic grief in the longer term, has been identified as especially important.2
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This article has been republished by kind permission of one of the authors, Richard Powell, and was first published in the BMJ in August 2020.
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