End-of-Life Care: Indian Perspective

Article excerpt

Byline: Himanshu. Sharma, Vankar. Jagdish, Prabhakaran. Anusha, Sharma. Bharti

According to Hinduism, the main religion of India, the end-of-life (EOL) deals with good and bad death. The WHO definition of palliative care stresses on improving not only the quality of life of patients facing incurable diseases but also their families by providing relief from the pain and suffering that includes the psychosocial and spiritual needs as well. The Indian Society of Palliative Care has been doing a commendable work and appreciable efforts are being done by the Kerala model of delivering the EOL care. The spiritual, ethical issues and ethical challenges raised when the patients are in terminal phase are also reviewed keeping in mind the socio-cultural norms. The Indian Penal Code (IPC) has lacunae, which hamper the physicians from taking proper decision in the EOL care. Some of the sections like IPC 309 are defunct and need to be changed. The Indian Society for Critical Care Medicine has developed a position statement on the patient management of the terminally ill patient in the Intensive Care Unit (ICU) which states that the society should move from the paternalistic model to the share based decision model of the West when deciding the fate of such patients. The literature review on the Indian research on palliative care shows very little emphatic results and the medical under graduates show illiteracy. To strengthen it Medical Council of India has included the palliative care in its curriculum by starting a PG course. Literature review revealed that more research from Indian perspective should be done in this area. This article studies the core issues of developing palliative care in Indian setting keeping in mind the ethical, spiritual and legal issues.

Introduction

Death is end-of-life (EOL) process and dying is the end process of the life. [sup][1] It can become stressful when one comes to know that he or she is going to die due to an incurable disease. We need to understand that to heal is more important than to cure. The World Health Organization definition of palliative care is set as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual". [sup][2] Thus, palliative care should focus on comprehensive pain management as well as increasing the quality of life of the patients. Palliative care can also reduce the fear of dying and prepares the family for bereavement. It is now getting attention due to the increasing number of people with terminal illness. [sup][3] Therefore, this review has been done to understand the spiritual, ethical, legal and cultural aspects associated with it.

Dame Cicely Saunders in the United Kingdom drew the attention of the medical community and the public to the evolution of palliative care in the 1960s. From the 1980s, rapid progress was made in developing palliative care as a discipline in the health-care delivery continuum of medical care. The recognition of palliative care as an integral part of cancer control policy and the guidelines for morphine in cancer pain relief by the WHO were salutary efforts made in the 1990s. These two factors propelled the national policies of many countries to implement palliative care in the last 20 years. In India, the earliest facilities to deliver palliative care within cancer centers were established in some places like Ahmedabad, Bangalore, Mumbai, Trivandrum and Delhi in the late 1980s and the early 1990s. The Indian Association of Palliative Care (IAPC) was formed in 1994, at the venue of a conference on palliative care held at Varanasi. [sup][4]

There are approximately 500 centers providing palliative care in India. The "Kerala Model" is very popular in the country with its own palliative policy. …