I began my career as a doctor in the British Army. During basic training with other doctors, nurses, pharmacists, lawyers and chaplains, we were presented with the following hypothetical scenario to discuss:

Your field ambulance station is about to be over-run by the enemy. Your medics have evacuated everyone they could – staff, mobile casualties and patients who were fit enough to transfer by ambulance to safety. One patient remains – severely unstable and unlikely to survive being moved from the station. Do you stay with the casualty, who may not survive, or do you leave them and go with the patients being evacuated?

We all chose the latter, arguing that our precious skills could achieve maximum good for the greatest number. In effect, we were prepared to sacrifice the most sick and vulnerable individual who needed us most for the greater number who needed us least. I remember how ashamed I felt when this was reflected back to us, as we were reminded that this level of courage explains the 29 Victoria Crosses (2 with bar) awarded to medical personnel.

This is the principle of non-abandonment upon which palliative care is founded.

“… no matter how poor the patient’s condition is, something can be done, and the skills of palliative care can and should be applied.” (Sheahan and Brennan, 2020).

Leave No One Behind (LNOB) is the second principle underpinning the universal values of the UN Sustainable Development Goals. It is a commitment to eradicate poverty, reduce inequalities and end exclusion, explicitly acknowledging that discrimination causes people to be left behind. People living with serious health-related suffering experience discrimination when they are denied access to palliative care and they are being left behind at their moment of greatest need. But simply recognising palliative care as part of Universal Health Coverage isn’t enough. We need to make palliative care services available and challenge our assumptions. Even where palliative care is available, patients and their families can feel abandoned when they are left with the sense that nothing further could be done and professionals “surrender into nihilism” that Sheahan and Brennan urge against.

Discrimination in palliative care goes deeper than organisational structures, services and competencies. These are the manifestations of assumptions and beliefs which we need to challenge, however uncomfortable that makes us feel. We must have courage and we must have compassion if we are to make real the powerful message from Dame Cicely Saunders, founder of the modern hospice movement:

‘You matter because you are you, and you matter to the end of your life.
We will do all we can not only to help you die peacefully, but also to live until you die.’

You can read more about the consensus definition of palliative care and add your endorsement here: Palliative Care Definition