The Impact of Climate Change on Hospice and Palliative Medicine

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Environmental changes, such as climate-related extreme weather events, are harmful to human health in numerous ways including rising respiratory illnesses, heat-related issues, waterborne diseases, and aggravated chronic conditions. Evidence suggests that vulnerable and marginalized populations, including those living with serious and life-limiting illnesses, are disproportionately more affected by environmental changes than others in society.

Harris and colleagues (2024) conducted a literature review to understand the existing literature of climate change’s impact on hospice and palliative medicine (HPM).

The researchers searched the English-language literature up to June 22, 2023 to identify research papers related to climate change and hospice and palliative care. Articles were included if they discussed the impacts of climate change and hospice care, palliative medicine, or end-of-life care in humans, and linked the two together. Twenty papers met the criteria and were included in the review.

From the review, six major themes emerged:

  1. The impact of climate change on HPM in low-income countries. Two articles described the impact of climate change on the experience of Malawian women nearing end-of-life. The studies identified that food insecurity was a barrier to quality of life and climate change led to worsening food insecurity and impacted social support systems for seriously ill women.
  2. Descriptive pieces on climate change, climate disasters, and HPM. Ten papers described a specific climate event. Common themes across multiple articles included challenges physically accessing patients due to road damage from trees, flooding, or downed electrical wires.
  3. Morbidity and mortality after climate disasters in the seriously ill population. Two articles described morbidity and mortality after climate disasters. One study found increased mortality 30 days after a hurricane, while another study found a threefold increase in mortality following a severe hurricane.
  4. Discussion of euthanasia during climate disasters. Three articles discussed ethical dilemmas arising from climate disasters, such as the possibility of euthanasia. The articles highlighted a 2005 scenario following Hurricane Katrina where a physician was accused of administering morphine and midazolam to four seriously ill patients with the intent of causing death. The physician believed they would not be evacuated and would consequently be left to die.
  5. Recommendations and frameworks for disaster response in the field of HPM. Three articles described frameworks for crisis standards of care, drawing on insights from previous disasters. These frameworks are intended to guide agencies and healthcare leaders in creating standards of care for disaster scenarios.
  6. Carbon footprint of hospices. One study investigated the carbon footprint of a 16-bed, inpatient hospice in southwest England, including emissions from staff, patients and family commutes.

This review also included narratives about the impact of wildfires on hospice and palliative care, describing “The Camp Fire” that occurred in the Sierra Nevada Mountains in 2018, and the impact of flooding on hospice and palliative care in Nigeria.

The study concluded that there has been little research on the impact of climate change on the field of hospice and palliative medicine. Common issues include: difficulties physically reaching patients and logistical challenges accessing medication or medical equipment, patients experiencing isolation and loss of social or community support, and increased mortality and referrals to hospice. Further, providers experience moral distress from new and complex challenges while also personally being impacted by the climate-induced disaster.

Preparedness was seen as a key component in providing better care during climate events. Further, common hospice and palliative care skills associated with delivering bad news and staying present, showing patients how to cope with the unacceptable, and to holistically approach suffering are all relevant to the complexities and distress of climate events.

Source: Harris, D., Chekuri, B., Schroll, A., Shah, N., Swende, L., Uzuegbu, C., & Young, P. (2024). The Impact of Climate Change on Hospice and Palliative Medicine: A Scoping and Narrative ReviewThe Journal of Climate Change and Health, 100323.

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