19g Travelling abroad

It is not uncommon for terminally ill patients to want to travel abroad in order to see family or to die in their home country. A wish to travel by air needs to be balanced against the risk to the individual and the inconvenience and cost to fellow passengers and airlines in the event of unscheduled changes to flight plans. If there is any doubt, the airline medical officer, who will give the final authorization, should be contacted well in advance of travel.

Changes in air pressure occur during flight and po₂ may be reduced. For this reason, patients with marked breathlessness (who are unable to walk more than 50 metres), with Hb less than 7.5g/L, ischaemic heart disease, cardiac failure or those who are oxygen-dependent may have difficulty.

In-flight cabin oxygen is inadequate for such patients. Extra supplies of oxygen may be made available as necessary if the airline is aware in advance.

Air expands at lower atmospheric pressures, and for this reason patients with a pneumothorax, large bullae, ear/sinus disease and recent surgery or colonoscopy should not fly without advice. Other conditions to consider carefully are intracranial tumours or confusion.

Patients will be at risk of thromboembolism on long-haul flights, especially if they are unable to mobilize adequately; the use of support stockings or foot rocking devices may be appropriate.

Transport to and from airports is arranged by the patient. If a stretcher is required, nine economy class seats are required, the cost of which is borne by the patient.

Cabin staff are not authorized to look after personal care needs, medical treatment or specialized medical equipment.

If a patient is taking regular controlled drugs, a Home Office licence will be required if the trip is longer than three months. If the dosage and therefore total quantity of drug is high, a licence may be required for less time away.

A letter from the prescribing doctor is required which is to be carried by the patient. The letter should contain the following information:

It is also advisable to contact the Embassy/Consulate/High Commission of the country being visited to ensure that they will not refuse entry to someone with controlled drugs.

Any patient travelling abroad should be advised to obtain travel insurance in the event of them becoming unwell. Getting travel insurance when a patient has an advanced disease can be difficult so they should be encouraged to look as early as possible. There are companies which specialize in providing cover for individuals with medical problems.

Although the European Health Insurance Card (EHIC) entitles the patient to free or reduced cost emergency treatment within the European Union, there is a risk that they will need to pay the costs at the time and then claim back the money. Also, the EHIC does not include medical evacuation back home. It is recommended that patients have both an EHIC and private travel insurance.

Home Office Licensing Department

For taking opioids abroad

Tel: 020 7035 4848