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References
1

Report of the United Nations Development Programme 2004 (HDI 2002). Launched by the United Nations in 1990, the Human Development Index measures a country's achievements in three aspects of human development: longevity, knowledge, and a decent standard of living. It was created to re-emphasize that people and their lives should be the ultimate criteria for assessing the development of a country, not economic growth. Current values range from 0.956 ( Norway, 1/177 countries) to 0.273 ( Sierra Leone, 177/177 countries). Countries fall into one of three groups: countries1-55=high development; 56-141=medium development; 142-177=low development.
See: http://hdr.undp.org/statistics/data/indic/indic_8_1_1.html

2
Oguz , N.Y., Miles, S. H., Buken, N., Civaner, M. (2003) End of life care in Turkey, Cambridge Quarterly of Healthcare Ethics, 12, 279-284
3
Questionnaire from International Palliative Care Initiative, Open Society Institute, New York: respondent - Dr Sevin Baser, Pulmonary Specialist and Assistant Professor, Pamukkale University Medical School – 2 November 2004
4
Email communication: Professor Yasemin Oguz – 18 September 2005
5
IOELC interview: Professor Serdar Erdine – 11 July 2005
6
Email communication: Professor Özgür Özyilkan – 28 September 2005
7
Eoin Tiernan (2004) Turkish Oncology Group website report on International Interim Meeting on Home Care and Hospice in Oncology, 7 – 9 October, 2004, Istanbul, Turkey
See: Link
8
IOELC interview: Dr Seref Komurçu – 18 April 2005
9
COPD = Chronic Obstructive Pulmonary Disease
10

IOELC Questionnaire: Dr Osman Abbasoglu – 5 March 2005

11
Turdal, N.S., Efe, B., Gamus, M., Aliustaoglu, M., Karamanoglu, A., Sengov, M. (2002) Patient satisfaction in the out patients’ chemotherapy unit of Marmara University, Istanbul, Turkey: a staff survey, BMC Cancer, 2: 30
See: http://www.biomedcentral.com/1471-2407/2/30
12
IOELC questionnaire: Dr Perran Fulden Yumuk and Dr Nazim Serdar Turdal – 20 July 2005
13
see Turkish Society of Algology http://www.algoloji.org.tr
14
Erdine, S. (1996) Turkey: status of cancer pain and palliative care, Journal of Pain and Symptom Management, 12 (2), 139-40.
15
WHO (1990) Cancer pain relief and palliative care: report of a WHO Expert Committee, Geneva: World Health Organization (Technical Report Series: 804)
16
IOELC interview: Professor Serdar Erdine – 11 July 2005
17
Questionnaire from International Palliative Care Initiative, Open Society Institute, New York: respondent - Dr Sevin Baser, Pulmonary Specialist and Assistant Professor, Pamukkale University Medical School – 2 November 2004
18
Email communication: Professor Yasemin Oguz – 18 September 2005
19
Savas, B. Serdar., Karahan, O., Saka, R. Omer., In Thomson, S. & Mossialos, E. (eds.) (2002) Health care systems in transition: Turkey. Copenhagen: European Observatory on Health Care Systems, 4 (4)
20
IOELC questionnaire: Professor Yasemin Oguz – 31December 2003
21

International Narcotics Control Board (2004) Narcotic Drugs: estimated world requirements for 2004. Statistics for 2002. New York: United Nations, 2004.

22
Selva, C. (1997) International control of opioids for medical use European Journal of Palliative Care 4(6), 194-198
23
see also United Nations (2005) Report of the International Narcotics Control Board2004, New York: United Nations http://www.incb.org/incb/en/annual_report_2004.html
24

‘The term defined daily doses for statistical purposes (S-DDD) replaces the term defined daily doses previously used by the Board. The S-DDDs are technical units of measurement for the purposes of statistical analysis and are not recommended prescription doses. Certain narcotic drugs may be used in certain countries for different treatments or in accordance with different medical practices, and therefore a different daily dose could be more appropriate.’ International Narcotics Control Board. Narcotic Drugs: estimated world requirements for 2004. Statistics for 2002.

25
IOELC interview: Professor Serdar Erdine – 11 July 2005
26
IOELC interview: Dr Deniz Yamac – 6 July 2005
27

The Middle East Cancer Consortium (MECC) was established in 1996 with the aim of setting up population-based cancer registries for member countries in order to monitor cancer incidence, mortality and epidemiology, promote preventative health policy and encourage research and educational links.

Silbermann, M. (2001) Perspectives for cancer epidemiology research in the Middle EastGastrointestinal Oncology, 4(2-3), 181-181.

The member countries as of July 2005 are Cyprus, Egypt, Israel, Jordan, Palestinian Authority and Turkey. Turkey joined MECC in June 2004. ( Freedman, L.S., Al-Kayed, S., Barchana, M., Boyiadzis, M., El-Najjar, K., Ibrahim, A.S., Salhab, A.R., Young, J.L., Roffers, S., Kahan, E., Qasem, M.B., Harford, J., Silbermann, M. Cancer Registration in the Middle East. Epidemiology 12:1, 131-133.) See: http://mecc.cancer.gov/registry.html

This country report was commissioned by MECC through the National Cancer Institute, Bethesda, following the MECC conference in Larnaca, 2 – 3 February 2004

28
IOELC interview: Dr Seref Komurçu – 18 April 2005
29
IOELC interview: Professor Serdar Erdine – 11 July 2005
30
MASCC The Multinational Association of Supportive Care in Cancer is an international, multidisciplinary organization with over 1000 members representing more than thirty countries and five continents. It operates in collaboration with the International Society for Oral Oncology. Founded in 1990, this group is dedicated to research and education in all measures of supportive care for patients with cancer, regardless of the stage of the disease. MASCC aims to promote professional expertise of supportive care through research and international scientific exchange of ideas. Significant advances in cancer treatment in the last two decades have been made possible by the strides in supportive care.’ For more details, see: http://www.mascc.org/
31
Eoin Tiernan (2004) Turkish Oncology Group website report on International Interim Meeting on Home Care and Hospice in Oncology, 7 – 9 October, 2004, Istanbul, Turkey
See: Link
32

Savas, B., Karahan, O., Saka, R., In Thomson, S. & Mossialos, E. (eds.) (2002) Health care systems in transition: Turkey. Copenhagen: European Observatory on Health Care Systems, 4 (4)

33
IOELC interview: Dr Deniz Yamac – 6 July 2005
34
Oguz , N.Y., Miles, S. H., Buken, N., Civaner, M. (2003) End of life care in Turkey, Cambridge Quarterly of Healthcare Ethics, 12, 279-284
35
Oguz , N.Y. (1996) Euthanasia in Turkey: cultural and religious perspectives, Eubios Journal of Asian and International Bioethics, 6(6): 170-171
36
Aksoy, S. (2003) Ethical considerations on end of life issues in Turkey, In K.Y. Song, Y.M. Koo, and D.R.J. Macer (eds.) Bioethics in Asia in the 21 st century (Eubios Ethics Institute)
See: www.biol.tsukuba.ac.jp/~macer/ABC4/abc4079.htm
(see also Arda, B. (2000) Evaluation of research ethics committees in Turkey, Journal of Medical Ethics, 26, 459-461)
37
 
38
Ozyalcin, N., Talu, G.K., Camlica, H., Erdine, S. (2004) Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain, European Journal of Pain, 8 (6), 539-545
39
IOELC interview: Professor Serdar Erdine – 11 July 2005
40
IOELC questionnaire: Professor Yasemin Oguz – 31December 2003
41
Oguz , N.Y., Miles, S. H., Buken, N., Civaner, M. (2003) End of life care in Turkey, Cambridge Quarterly of Healthcare Ethics, 12, 279-284
42
IOELC questionnaire: Professor Yasemin Oguz – 31December 2003
43
Email communication: Professor Yasemin Oguz – 4 August 2005
44
IOELC questionnaire: Dr Perran Fulden Yumuk and Dr Nazim Serdar Turdal – 20 July 2005
45
Email communication: Dr Eoin Tiernan – 10 March 2005
46
IOELC interview: Dr Seref Komurçu – 18 April 2005
47

Kav, S. (2005) Cancer Nursing Education in Turkey, Report for ISNCC – International Society of Nurses in Cancer Care
See: http://www.isncc.org/lists.asp?Table=News&Page=Turkey
(Sultan Kav is an Oncology Nursing Educator at Hacettepe University Hospital and a member of the Turkish Oncology Nurses Association)

48
National Cancer Bulletin: Eliminating the suffering and death due to cancer (2004) Special Issue National Cancer Institute 1:43, November 9
See: http://www.cancer.gov
49

State Institute of Statistics (T.C. Basbakanlik, Devlet Istatistik Enstitusu) (2004) Turkey’s Statistical Yearbook 2004, State Institute of Statistics, Prime Ministry, Republic of Turkey
See: http://www.die.gov.tr/yillik/yillik_2004_eng.pdf
Actual figures: 89, 077 male and female total circulatory deaths /184,330 male and female total all deaths

50

Savas, B., Karahan, O., Saka, R., In Thomson, S. & Mossialos, E. (eds.) (2002) Health care systems in transition: Turkey. Copenhagen: European Observatory on Health Care Systems, 4 (4)

51
See: http://www.cia.gov/cia/publications/factbook/geos/ug.html
52

This refers to adult mortality risk, which is defined as the probability of dying between 15 and 59 years.

53
See World Fact Book
See: http://www.cia.gov/cia/publications/factbook/geos/ug.html
54
See: WHO statistics for Turkey at: http://www.who.int/countries/en/
55

State Institute of Statistics (T.C. Basbakanlik, Devlet Istatistik Enstitusu) (2004) Turkey’s Statistical Yearbook 2004, State Institute of Statistics, Prime Ministry, Republic of Turkey
See: http://www.die.gov.tr/yillik/yillik_2004_eng.pdf
Actual figures: 89, 077 male and female total circulatory deaths /184,330 male and female total all deaths

56

State Institute of Statistics (T.C. Basbakanlik, Devlet Istatistik Enstitusu) (2004) Turkey’s Statistical Yearbook 2004, State Institute of Statistics, Prime Ministry, Republic of Turkey
See: http://www.die.gov.tr/yillik/yillik_2004_eng.pdf
Actual figures: 23,775 male and female total deaths from neoplasm /184,330 male and female total all deaths

57
‘ The Izmir Cancer Registry (ICR) is a recording and research centre that collects cancer data from the whole population in line with international standards, since April 1992. Not only all of the hospitals of Izmir province concerned with cancer diagnosis and/or therapy, but also all oncology centres and pathology laboratories are among the data resources of ICR. Software of ICR is CanReg-4 of IARC (International Agency for Research on Cancer) and the coding base is the Turkish version of ICD-O-3. ICR is a member of IARC (International Association of Cancer Registries) and ENCR (European Network of Cancer Registries).’ The first international paper of the centre was published in 2001: Fidaner, C., Eser, S.Y., Parkin, D.M. (2001) Incidence in Izmir in 1993–1994: first results from Izmir Cancer Registry, European Journal of Cancer, 37, 83-92.
See: http://mecc.cancer.gov/turkey.html
58
Izmir Cancer Registry http://www.ato.org.tr/konuk/kidem/Edoc3.htm
59
See: http://www.unaids.org/en/geographical+area/by+country/turkey.asp
60

State Institute of Statistics (T.C. Basbakanlik, Devlet Istatistik Enstitusu) (2004) Turkey’s Statistical Yearbook 2004, State Institute of Statistics, Prime Ministry, Republic of Turkey
See: http://www.die.gov.tr/yillik/yillik_2004_eng.pdf

61
State Institute of Statistics (T.C. Basbakanlik, Devlet Istatistik Enstitusu) (2004) Turkey’s Statistical Yearbook 2004, State Institute of Statistics, Prime Ministry, Republic of Turkey
See: http://www.die.gov.tr/yillik/yillik_2004_eng.pdf
62

Total health expenditure per capita is the per capita amount of the sum of Public Health Expenditure (PHE) and Private Expenditure on Health (PvtHE). The international dollar is a common currency unit that takes into account differences in the relative purchasing power of various currencies. Figures expressed in international dollars are calculated using purchasing power parities (PPP), which are rates of currency conversion constructed to account for differences in price level between countries.
See: Link

63
Tandon A, Murray CLJ, Lauer JA, Evans DB. Measuring overall health system performance for 191 Countries. GPE Discussion Paper Series: No 30; WHO
64
Savas, B., Karahan, O., Saka, R., In Thomson, S. & Mossialos, E. (eds.) (2002) Health care systems in transition: Turkey. Copenhagen: European Observatory on Health Care Systems, 4 (4)
65

Ministry of Health, Ankara, 2001 http://www.saglik.gov.tr

66

Email communication: Professor Yasemin Oguz – 18 September 2005

67
Savas, B.., Karahan, O., Saka, R., In Thomson, S. & Mossialos, E. (eds.) (2002) Health care systems in transition: Turkey. Copenhagen: European Observatory on Health Care Systems, 4 (4)
68
Oguz , N.Y., Miles, S. H., Buken, N., Civaner, M. (2003) End of life care in Turkey, Cambridge Quarterly of Healthcare Ethics, 12, 279-284
69
See: http://www.cia.gov/cia/publications/factbook/geos/ug.html
70
See: http://www.cia.gov/cia/publications/factbook/geos/ug.html
71
The Turkish Code of Medical Ethics (1960) supports this attitude: ‘The physician must openly tell the patient the measures that should be taken in his/her situation, if it is not likely to make his/her illness worst by disturbing his/her mood, unless it seems appropriate to hide a serious prognosis.’ (Information supplied by Prof Yasemin Oguz, 18 September 2005)
72
Ornek Buken, N. (2003) Truth-telling information and communication with cancer patients in Turkey, JISHIM, 3, 31-36
See: http://www.ishim.net/ishimj/4/05.pdf
73
Aydin, E. (2004) Rights of patients in developing countries: the case of Turkey, Journal of Medical Ethics, 30, 555-557
74
Arda, B. (1995) Bioethics in Turkey, Eubios Journal of Asian and International Bioethics, 5, 64-65
75
IOELC interview: Dr Deniz Yamac – 6 July 2005
76
Oguz , N.Y., Miles, S. H., Buken, N., Civaner, M. (2003) End of life care in Turkey, Cambridge Quarterly of Healthcare Ethics, 12, 279-284
77
Oguz , N.Y. (1996) Euthanasia in Turkey: cultural and religious perspectives, Eubios Journal of Asian and International Bioethics, 6, 170-171
78
Aksoy, S. (2003) Ethical considerations on end of life issues in Turkey, In K.Y. Song, Y.M. Koo, and D.R.J. Macer (eds.) Bioethics in Asia in the 21 st century (Eubios Ethics Institute)
See: www.biol.tsukuba.ac.jp/~macer/ABC4/abc4079.htm
79
Bozcuk, H.,  Kolagasi, O., Samur, M., Yıldız, M., Ozdogan, M., Artac, M. Savas, B. (2003) A Brief Information Sheet On Opioid Effects Improves Quality Of Life In Cancer Patients On Opioids, The Internet Journal of Pain, Symptom Control and Palliative Care, 2: 2
See: Link
80
IOELC interview: Professor Serdar Erdine – 11 July 2005
Further Reading

http://www.who.int/cancer/palliative/en/

Center for Bioethics (2005) End of life care: an ethical overview, University of Minnesotahttp://www.bioethics.umn.edu/publications/End_of_Life.pdf

Erdine, S. (1996) Turkey: status of cancer pain and palliative care, Journal of Pain and Symptom Management,12(2), 139-40.

Erdine, Serdar (2004) Education and sub-specialisation in pain medicine , paper given at ‘The Global Day against Pain’, Geneva, Switzerland -11 October 2004 http://www.efic.org/2005news.htm

Gozum, S., Tezel, A., Koc, M. (2003) Complementary alternative treatments used by patients with cancer in eastern Turkey, Cancer Nursing, 26 (3), 230-236

Livneh, J., Garber, A. & Shaevich, E. (1998) ‘Assessment and documentation of pain in oncology patients’ International Journal of Palliative Nursing 4(4) pp.169-175

Oguz , N.Y. (1999) Narrativity in bioethics: with special reference to medical ethics, Eubios Journal of Asian and International Bioethics, 9, 130-134

Oguz , N.Y. (2002) Autonomy: cutting the Gordian knot Bioethics Examiner, 6:1,

Oguz , N.Y., Miles, S. H., Buken, N., Civaner, M. (2003) End of life care in Turkey, Cambridge Quarterly of Healthcare Ethics, 12, 279-284

Ott, BB. Al-Khadhuri J. Al-Junaibi S. Preventing ethical dilemmas: understanding Islamic health care practices. Pediatric Nursing, 2003; 29(3):227-230.

Savas, B. Serdar., Karahan, O., Saka, R. Omer., In Thomson, S. & Mossialos, E. (eds.) (2002) Health care systems in transition: Turkey. Copenhagen: European Observatory on Health Care Systems, 4 (4)

Stjernswärd J, Clark D. Palliative medicine – a global perspective. In: D Doyle, G Hanks, N Cherny, K Calman (eds.) Oxford Textbook of Palliative Medicine. Oxford: Oxford University Press, 2003.

Turdal, N.S., Efe, B., Gumus, M., Aliustaoglu, M., Karamanoglu, A., Sengov, M. (2002) Patient satisfaction in the outpatients’ chemotherapy unit of Marmara University, Istanbul, Turkey: a staff survey BMC Cancer, 2: 30 http://www.biomedcentral.com/1471-2407/2/30


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