Palliative care evolved with the recognition of subjectively experienced human suffering at the end of life. However, suffering becomes addressable at scale only when recognised, prioritised, and acted upon through social institutions. This paper examines how an understanding of consciousness and suffering shapes the governance and distribution of palliative care within health systems, with implications for global inequities in palliative care. Based on an interdisciplinary synthesis of social science, bioethics, and the global health policy literature, this paper analyses why palliative care remains unevenly integrated, despite strong normative commitments at the international level.

There are persistent asymmetries between high-income and low- and middle-income countries (LMICs) in palliative care coverage and access to essential medicines, especially opioids. These inequities are not attributable solely to differences in economic resources, but are also mediated by institutional mechanisms, such as regulatory regimes, health financing structures, workforce authority, and political prioritisation. Examples are used to illustrate how alternative institutional arrangements, such as task shifting in opioid prescribing and community-based care platforms, can expand access even in resource-constrained settings.

Palliative care should be conceptualised as a social institution grounded in shared human consciousness. Inequitable access reflects differences in how societies value, govern, and operationalise suffering. Addressing these disparities requires not only clinical capacity but policy coherence, proportionate regulation, and accountability mechanisms that recognise the relief of suffering as a core obligation of health systems.