Foreword
The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA), the Canadian Hospice and Palliative Care Association (CHPCA), and the Canadian International Development Agency (CIDA), sponsored the satellite session “Palliative Care in Resource-Constrained Settings for People Living with HIV/AIDS and Other Life-Threatening Illnesses” at the 14th International Congress on the Care of the Terminally Ill, in October 2002. This session was programmed to highlight and learn from palliative care initiatives in resource-constrained settings and to foster greater collaboration and exchange among industrialized and developing countries. At this 1-day session in Montreal, we heard from providers and advocates who embody some of the most advanced thinking on palliative care in the world today.
It is hard to identify a disease that has caused more physical, psychological, and spiritual suffering over the past 25 years than AIDS. People living with life-threatening illnesses, their loved ones, and their caregivers have long recognized that care is about more than a cure. Those concerned with the shortcomings of many care systems have searched for a framework within which to address physical and emotional suffering as well as the spiritual, psychological, and clinical needs of the “whole person.” For many, that framework is palliative care.
In 2002, reflecting the rapid advancement of palliative care in practice, the World Health Organization expanded its definition of palliative care to say that “[it] is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.”
This publication includes many of the presenters at the satellite session. These authors present a fascinating set of perspectives on such questions as, When does palliative care start? They also speak to the challenges of ensuring that palliative and curative care are not either–or propositions. Many authors share success stories that reveal how palliative care has been provided in even the most limited resource settings. Together, the contributions of these leaders promise an enriching encounter for the rapidly growing community of providers, advocates, and patients interested in palliative care.
As one presenter at the Montreal conference put it, “The person who needs palliative care is not only dying, but is also living, and our job is to help the person live fully.” This statement is, in many ways, a call to eliminate the struggle between curative treatment and palliation, to ensure an approach to provider and consumer education that integrates palliative and curative principles, and to guarantee access for people living with life-threatening illnesses to a continuum of care that is fully responsive to their needs throughout the course of their lives. On behalf of the organizations we represent and our partners around the globe, we hope you will join us in meeting these challenges.
Bernard Lapointe, M.D.
Chief, Division of Palliative Care
Jewish General Hospital
Montreal, Quebec, Canada
Joseph F. O’Neill, M.D., M.P.H.
Director
White House Office of National AIDS Policy
Washington, DC, USA
