No one wants to die in solitude. No one wants to feel forgotten and left alone when dying. Palliation means to lessen or to ease something painful. Palliative care is derived from palliation. It deals with easing the pain at the end of one’s life in dealing with terminal illnesses.
Hospices provide for supportive care when treating a disease. But supportive care with the right psychological, emotional, pain management is called palliative care. Palliative care requires a team of people who are trained in not just medicine. So we need doctors, nurses, spiritual healers, staff to deal with the care of patient. Now we must note here that illnesses are treated in hospitals to treat the disease. But when complete cure is not possible, mainly in old age, people need to be given long term care beyond medicines. In many cases like cancer, where chemotherapy causes devastating side effects and pain, patients require pain relieving medication.
Pain relief has become difficult to prescribe since the Narcotic Drugs and Psychotropic Substances Act, 1985*. Government regulation had then decreased the usage of narcotics to cure pain by a whooping 92% . Whereas, the world’s usage of narcotics to cure pain had increased by more than 400%.
This gave thrust to the underground black market of drugs smuggled and sold without regulation and quality checks. This led to abuse. The main aim to control misuse of drugs has been misplaced.
Only 1% of Indian population ever gets palliative care at the sunset of their lives. Palliative care should not be just for the rich. India lags far behind in one of the worst countries to die in, in the Quality of Death index. Death should not be made more scary of an experience. Every person has a right to lessen the pain and improve quality of their lives.
Palliative care is a relatively new concept in india. We have inadequate awareness about the term palliation and its advantages. According to a survey, more than 83% of Indian population want to die in the comfort of their homes. Surely, palliative care at home can be cost effective too. But lack of space, lack of money and increasing out of pocket expenses render the care givers at home helpless.
Charities and NGOs who are doing pioneering work in palliative care must be given their due support financially. Governments of India launched the national Cancer Control program in 1975, which was later modified in 1984 to include pain relief as a basic service under primary health care. India saw the formation of Indian Association of Palliative Care(IAPC)** in 1994. With the help of WHO, IAPC started various palliative care centers across India.
But today, due to the NDPS act , opioids like morphine remain inaccessible to 98% of the patients. Whereas the abusers abuse morphine giving in to their addictions. This dichotomy must end. End of life care must be given with due respect to the people of India. More research is required in this filed.
Finally, we need to incorporate palliative care in healthcare policies to bring it to the fore. This initiative has been thwarted by the World Health Association (WHA). India awaits the change to happen. Even if baby steps are taken , a huge impact will be awaited in decades to come by.
References:
* https://indiankanoon.org/doc/1727139/
** https://hospicecare.com/global-directory-of-providers-organizations/listings/details/124/#:~:text=The%20Indian%20Association%20of%20Palliative,institutions%20involved%20in%20palliative%20care.
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