Pain management for palliative care patients with disabilities: revisiting morphine prescription policies in developing contexts

People with disabilities often have increased healthcare needs and lower socio-economic status which particularly disadvantages them when free markets are emphasized over the right to health. Any terminal illness requiring palliative care compounds the situation and further disempowers patients with disabilities. This chapter discusses how restricting prescriptions to medical doctors results in the underutilization of drugs, unnecessary patient suffering, denial of an inalienable right to dignified healthcare and frustration of unauthorized health personnel who watch helplessly as terminally ill patients with disabilities live and die in avoidable pain. The chapter analyses policy challenges and opportunities opened by the 2014 World Health Assembly resolution to improve palliative care, as developing nations negotiate statutory regulations that restrict prescription of the drugs that people need to elite but unavailable medical personnel. Using the example of Zimbabwe, where complex negotiations resulted in a significant policy shift, the chapter synthesizes the critical processes of involving multiple stakeholders in activism advocating for the development of pain management policy guidelines that align with the WHA resolution to ensure accessible palliative care and the importance of the African cultural context of Ubuntu in which palliative care takes place. Despite disparities that still exist between disabled and non-disabled patients in accessing palliative care in home-based care settings, the chapter draws lessons that could be used to ameliorate situations in other developing nations and improve access of people with disability to healthcare rights.