I’d always taken it for granted that palliative care is a good thing when it is available, but I hadn’t gone the extra step to think about whether someone has a right to receive it, or whether it would be a duty for an individual or hospital or state to provide it.
Prof John Keown addressed these issues last month in a meeting at the House of Lords put on by the Anscombe Bioethics Centre. His argument was fairly simple. There are many different ethical systems, and they would lead you to conflicting conclusions about many moral issues. But despite this, there would be a consensus about the importance of the relief of unnecessary human suffering and the provision of holistic support for those with serious health issues. And Keown concluded that it would be unethical to fail to meet the need of palliative care when it can reasonably be met, e.g. in countries like the UK with good healthcare resources.
Here is a definition, from NICE, quoted on the National Council for Palliative Care website:
Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments.
Is it also a human right? Keown argued that there is a duty to provide palliative care because of the internationally recognised right to healthcare. So the lack of access to palliative care should be seen as a global human rights issue. This might seem a bit extreme, but he pointed out that there is already a right to avoid ‘degrading treatment’ inscribed in the European Convention on Human Rights, Article 3. And he went on to explore the different ways in which civil and criminal law in the UK already implicitly recognise the duty of providing palliative care.
At the end of his talk Keown speculated about how much palliative care could be improved if the provisions that presently applied to animals in this country (through the 2006 Animal Welfare Act) could be extended to human beings. This summary is from the Freshfields Animal Rescue site:
Owners have a “Duty of care” to the animals they keep which is a legal phrase meaning that owners have an obligation to do something. Prior to the Animal Welfare Act 2006, people only had a duty to ensure that an animal didn’t suffer unnecessarily. The new Act keeps this duty but also imposes a broader duty of care on anyone responsible for an animal to take reasonable steps to ensure that the animal’s needs are met. This means that a person has to look after the animal’s welfare as well as ensure that it does not suffer.
The Act defines “animal” as referring to any living vertebrate animal, although there is provision to extend this if future scientific evidence shows that other kinds of animals are also capable of experiencing pain and suffering.