UAE’s end-of-life care needs major improvements, nurse report says

Addiction fears over the use of opiates in pain relief, religious beliefs and the law are all potential stumbling blocks to improving care for the terminally ill.

ABU DHABI // Care of the terminally ill is being hampered by out-of-date laws on resuscitation and misplaced fears over opiate addiction.
A taskforce on the issue has also found that symptoms are often improperly diagnosed and there is a shortage of options for advanced pain management.
The drawbacks mean the UAE has no chance of meeting World Health Organisation global targets for palliative care by 2020.
"The challenges are huge," said Nesreen Al Alfi, of Fatima College for Health Care Sciences in Abu Dhabi, a member of the Health Authority Abu Dhabi taskforce looking at where improvements can be made.
"Even when the language and culture barriers are down, I still see defects in caring for those patients because of a lack of training and structured programmes for palliative care."
Nurses trained in caring for the terminally ill work at Tawam Hospital in Al Ain, the national oncology centre, and at Sheikh Khalifa Medical City, where there is a home-care team.
"Another hindrance here in the UAE is the legal system," said Ms Al Alsi, whose views were published in the Journal of Palliative Care and Medicine. "There are no approved policies for 'do not resuscitate' or 'allow natural death'.
"Not intervening acutely and aggressively, even when intervention is not advised or proven to be medically futile, can be punished by law."
The World Health Organisation says 40 million people a year worldwide need palliative care, but 86 per cent will not receive it. Almost all terminally ill children in low to middle-income countries live in pain.
Palliative care is integrated into the health systems of 20 nations, but none is in the Middle East and the WHO target of worldwide palliative care by 2020 will not be met, experts say.
Dr Stephen Connor, executive director at the Worldwide Hospice Palliative Care Alliance, said the US and UK models took decades to develop. "I don't think it is realistic for all countries to have such services by 2020. The best way to change attitudes and minds is by showing the value of palliative care.
"When you explain the evidence that resuscitation in this population is almost always ineffective and turns the dying experience into a trauma for everyone, it is easier to at least allow the patient or surrogates to decide."
Debunking addiction myths surrounding the use of opiates in pain management was another vital education area that could help reduce suffering, said Dr Connor.
"We rarely see addictive behaviour in our patients. Addiction or substance use disorders are a psychological illness. When patients are in pain and an opioid is used, the person doesn't experience a 'high', just pain relief.
"The other reality is our patients die while on opioids so there is no concern about addiction or withdrawal.
"Requiring that all persons be resuscitated means no one can have a peaceful death. Modern ethics should also require that patients have the right to accept or refuse any treatment, including resuscitation."
The Care2Save charitable trust has launched a campaign to raise funds for palliative care around the world. People who donate Dh5.20 will be entered in a draw, with a luxury car as the prize.
"What's crucial in many countries like the UAE is having a comprehensive provision of care, and the legal aspect of having unrestricted, available morphine," said Siobhan Horton, from Care2Save, who was a Macmillan cancer nurse in the UK for a decade.
"There is a legal framework blocking the way for preventable suffering in some countries.
"There are no religious reasons but maybe there are cultural issues behind people believing it is OK for them to suffer."
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