Care of Dying Is Outlined by W.H.O.

By DONALD G. McNEIL Jr.
Saying that “everyone has the right to be treated, and die, with dignity,” the World Health Organization yesterday issued its first guide to planning end-of-life care.
The 51-page document was aimed not at individual doctors, but at national health ministers, said one of its authors, Dr. Cecilia Sepúlveda, palliative care expert with the health organization.
It contains formulas for calculating how many people in a country are in need of such care.
It also outlines typical obstacles to providing it: national laws that make it hard for pharmacists to stock powerful painkillers, lack of training for doctors and nurses, and fears of addiction on the part of patients.
It also cites countries that offer good end-of-life care despite national poverty — mostly by having it done at home, by relatives given modest amounts of training.
The “most impressive” programs that Dr. Sepúlveda said she had found were in Uganda and in the state of Kerala in India. In both places, political leaders and medical doctors had combined their efforts.
In 2005, more than seven million people died of cancer, and 70 percent of them were in poor or middle-income countries where there was little money for diagnosis or treatment, the health organization report said. Unless a cure is found for cancer, more than 11 million people will die of it each year by 2030.
Although the report was initially written for countries preparing national cancer plans, it is also useful in countries with many people dying of AIDS or experiencing any other slow, painful death, Dr. Sepúlveda said.