Palliative care in resource-poor settings-identifying the ethical questions and challenges faced during a global pandemic

Background:
As the COVID-19 pandemic evolves healthcare organizations in the UK, US, and Europe have called for greater access to palliative care. This call has been echoed by palliative care practitioners in the low- and middle-income countries (LMICs). While the need for palliative care may be universal, there are cultural and resource differences between the high-income countries where palliative care and its ethical principles was first developed and the LMICs. These differences may have an impact on the application of ethical principles to palliative care which could hamper efforts to deliver palliative care in areas where the need is greatest. Many key challenges to the delivery of palliative care in LMICs, particularly during public health emergencies, remain unaddressed and in some cases, unidentified.
Aims:
To review the literature on the delivery of palliative care in public health emergencies and the COVID-19 pandemic. We sought to identify key challenges and questions on how LMICs should deliver culturally sensitive, ethically acceptable palliative care at scale. Approach taken We conducted a search of the recent literature on the challenges of delivering palliative care in public health emergencies such as the COVID-19 pandemic. Our analysis grouped the challenges according to emergent themes. We then defined questions with which to interrogate each theme, and the components that must be investigated to answer the questions.
Results:
Four challenge themes and defining questions to be addressed were identified.
Conclusion:
To deliver palliative care successfully during public health emergencies in resource-poor settings, several questions have to be considered. Answering these questions will require targeted research and discussion across disciplines and around the world.