Stakeholder consultation is part of the democratic process, embraces
respect for persons, and is necessary for upholding the principle of
justice. People are more likely to uphold standards they have participated
in setting, so stakeholder consultation encourages adherence to societal
and institutional standards as these evolve. Stakeholder consultation is
also responsive to the call to “resocialize” ethics by
contextualizing dilemmas and involving the destitute in choices about
their healthcare. In resource-poor settings, such consultation promotes
local “ownership” of, and leadership within, development
programs, which enhances effectiveness and sustainability. Stakeholder
consultation is, therefore, a form of capacity building. To succeed, it
must be responsive to regional, national, and individual constraints,
including socioeconomic, cultural, and political ones. Several such
constraints impact on the demand for, and availability of, palliative
healthcare in the Caribbean.David Joranson
and Jody Garthwaite at the Pain and Policy Studies Group kindly provided
morphine consumption data and Figure 1. Bert Braithwaite and Trevor Noel
provided useful comments on the manuscript.