Reports from IAHPC Board Members
International Programs at the Institute for Palliative Medicine at San Diego Hospice
The Education in Palliative and End-of-Life Care (EPEC) Curriculum was developed and disseminated by the EPEC-Project at the American Medical Association. Frank D. Ferris was invited to join Dr. Jan Stjernswärd in Lebanon and Jordan in 2001 to teach using this curriculum. Following a number of educational collaborations that included Dr. Stjernswärd, the International Palliative Care Initiative at the Open Society Institute (New York City), the Office of International Affairs at the National Cancer Institute (Bethesda, Maryland), the World Health Organization, the International Association for Hospice and Palliative Care, and partners in multiple countries, an International Program was formed at the Institute for Palliative Medicine (IPM) at the San Diego Hospice (SDH) during 2007.
The aims of the International Program are “to create, demonstrate and implement successful strategies for integrating palliative care into existing health care systems in low and moderate resource countries.” Through a multi-year strategic plan we intend to:
- build capacity to support the successful implementation of palliative care in selected countries;
- establish optimal interventions (policy, educational, program implementation, etc.) to integrate palliative care in low and moderate resource countries;
- demonstrate successful implementation of palliative care in the Middle East, Eastern Europe, Southeast Asia, and Latin America where we have a capacity-building partner who will fund knowledge transfer and who has a commitment from either the government or a major health care system within the country to create a palliative care infrastructure;
- capture and communicate culturally-specific information about care from countries so that the SDH staff (and others) can use this to improve the care provided at SDH and beyond; and
- disseminate the lessons learned following the integration of palliative care in low and moderate resource countries and to identify those interventions that may improve the integration of palliative care into the existing health care systems within the US.
Today, the faculty and staff of the International Programs at the IPM are involved in a number of in-country educational interventions that include sensitization presentations, and introductory bedside training courses (1-3 weeks) with an objective to develop basic skills in palliative care for all healthcare workers.There is also an advanced level palliative care skills training program for healthcare workers seeing a lot of patients with advanced illness, e.g., AIDS, cardiology, geriatrics, oncology, pulmonology, etc.
All clinicians interested in gathering information about palliative care and related educational resources are invited to visit and contribute to our new web portal, The International Palliative Care Resource Center which was launched on October 1, 2009 at http://www.IPCRC.net. This site is designed for ease of use and to be a single point of access, even for low-speed communication links.
Once physicians decide that they have an interest in specializing in palliative medicine, and have the administrative support to do so, IPM has two educational programs available: a Visiting Scholars program to give them a taste of what specialty training will look like, and a formal International Palliative Medicine Fellowship (IPMF) Training program that is based on US fellowship training standards. During the 2 – 3 years of a customized IPMF, the fellow will develop a palliative care program in her/his home institution, make 4-6 visits (of 4-6 weeks each) to San Diego to learn skills in clinical medicine, teaching, program development and quality improvement. IPM faculty will visit the fellow’s program 2-3 times to mentor and co-present introductory and advanced courses to her/his colleagues.
The focus of these two programs is hands-on bedside training during which trainees evaluate real patients and their families and participate in decision-making and care planning in collaboration with California-licensed physicians and all the members of our interdisciplinary teams – trainees are not simply observers.
During 2008-9, IPM faculty were involved in educational programs in Cyprus with the Middle East Cancer Consortium, Egypt, Georgia, Jordan, Saudi Arabia, Slovenia, Vietnam, and the Ukraine. Four fellows have graduated from our IPMF program; 7 are currently enrolled; we anticipate several new fellows will start in 2010.
Clinicians of any discipline, as well as administrators, are invited to visit SDH as observers to learn more about the way our comprehensive palliative care program cares for over 1,000 patients per day who have advanced illnesses and more than 12,000 bereaved persons per year across a large county (3.2 million population) in multiple care settings.
Palliative medicine experts, who are working to become local, regional or global leaders, now also have an opportunity to participate in our new International Palliative Care Leadership Development Initiative. This new 2-year skill-building curriculum is a pilot project funded by the Open Society Institute with additional funding provided by the Office of International Affairs of the National Cancer Institute and the Diana, Princess of Wales Memorial Fund and it aims to “grow global leaders… advance palliative care.”
Scholars involved in any discipline are also invited to be Scholars-in-Residence for one or more months to engage in special educational or research projects related to palliative care.
Anyone interested to learn more about our International Programs is invited to contact us at:
Frank D. Ferris, MD, FAAHPM
Director, International Programs
Institute for Palliative Medicine at San Diego Hospice
4311 Third Ave
San Diego, California, USA92103-1407
E-mail:[email protected]
Phone:+1.619.278.6225
Dr. Ferris is an IAHPC Board Member, formore information go to: http://www.hospicecare.com/Bio/f_ferris.htm
Assisted Suicide in the United Kingdom
Regular readers of this Newsletter will know that the debate on euthanasia continues in the UK as in many other countries. Recently, public attention seems to have moved from euthanasia to assisted suicide. This brief communication reports and discusses the latest events because, so the author believes, most westernised societies may soon have similar challenges and debates.
In three countries in the UK (England, Wales and Northern Ireland), assisting suicide is a criminal offence carrying a maximum prison sentence of 14 years. The fact that no-one has ever been convicted has been of little comfort to those contemplating suicide, particularly in Switzerland in the Dignitas Clinic. Might their relatives and friends be prosecuted for accompanying them or making travel arrangements to end their lives there?
At the end of September the law was clarified much to the delight of those in favour of assisted suicide and / or euthanasia. It has now been explained that provided the patient has consistently expressed a wish to end his / her life, that the patient is in the late stages of a fatal illness, and that those assisting do not stand to gain any financial reward then there will be no prosecution.
Reassuring as this may seem to be, it leaves many unanswered questions. If the suicide takes place in the UK will there be doctors willing to prescribe the necessary drugs? Is this the stage before legalisation of euthanasia? Will assisted suicide clinics similar to Dignitas spring up in the UK to save patients from travelling to Zurich to end their lives? Will the suspicion arise that patients dying in palliative care units are, in fact, being helped to die, the old “ double effect”, that might be strongly denied by the palliative care physicians and nurses? What safeguards and records will be needed in general hospitals and, indeed, in hospice and palliative care units? Just where will doctors (particularly general practitioners / family physicians) fit into this picture?
To many of us it feels as if the clarification process has “mudded” the waters.
Derek DoyleOBE, MD (Scotland)
Dr. Doyle is an IAHPC Board Member; for more information please go to: http://www.hospicecare.com/Bio/d_doyle.htm
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