A 70-year-old patient with melanoma passed away at the palliative care unit at the National Cancer Institute in Mexico City, Mexico on August 28, 2014. His daughter brought him in earlier that day, after traveling with her father for hours because palliative care was not available close to their home.

© 2014 Ed Kashi/VII Photo for Human Rights Watch

(Mexico City) – The Mexican Health Ministry took an important step on December 09, 2014, to ensure access to palliative care for people suffering from pain due to incurable illness, Human Rights Watch said today. The government released long-awaited guidelines to its healthcare system that will operationalize provisions on end-of-life care outlined in Mexico’s 2009 health law. 

“The publication of these guidelines is an important step toward ensuring that people who are dying in Mexico not only have a right to care in theory but also in practice,” said Diederik Lohman, associate health director at Human Rights Watch. “Now Mexico’s progressive law can finally be put into operation.”

In October Human Rights Watch highlighted, in a 122-page report, the barriers faced by tens of thousands of patients who suffer unnecessarily from severe pain and other symptoms. Although the Health Ministry was supposed to issue the guidance within six months of the 2009 law coming into effect, it was held up for years, delaying the effect of the law.

Mexico’s health law offers extensive rights to people who are terminally ill and have six months or less to live. It states that all hospitals should offer palliative care to such patients, including in their homes, and that all healthcare workers should receive adequate training in palliative care.

The Human Rights Watch report found that, in practice, the availability of palliative care is uneven and limited throughout the country. Seven of Mexico’s 32 states did not have a single hospital that offered palliative care and in another 17 states, palliative care services only existed in capital cities. Estimates by the World Health Organization and the Worldwide Hospice and Palliative Care Alliance suggest that more than half of the 600,000 people who die every year in Mexico require palliative care.

The guidelines provide detailed direction to hospitals and healthcare providers on when palliative care should be offered; the procedure for initiating it; and criteria for providing it in different settings, such as the patient’s home, outpatient clinics, or a hospital. The guidelines emphasize the importance of ensuring that patients can remain in their homes while receiving palliative care.

“This is a positive step, but the real challenge is to ensure that hospitals actually follow the guidance and patients have access to the palliative care that the health law guarantees,” Lohman said. “The government should set clear targets and hold the healthcare system to account.”
In another key development, on December 5, Mexico’s Public Health Council approved an agreement between government agencies on the development of palliative care. The agreement lays the foundation for critical reforms regarding the prescription of opioid analgesics and healthcare worker education.