Choosing a dignified exit

To end cruelty to an imminently departing soul, palliative care is the answer

Published - May 17, 2016 12:35 am IST

Modern medicine has advanced a lot — which is indeed a boon to humanity. Even a limb severed in an accident can now be stitched back by doctors under certain conditions using modern techniques. One who suffers a heart attack can lead a normal life with the help of a bypass surgery or angioplasty. A stroke victim can be saved if he or she is rushed to a good hospital within the golden hour. But at the same time, there is a very different aspect of modern medical practice that is seen to be manifesting itself increasingly.

Death by intensive care

Simone De Beauvoir, in her book, A Very Easy Death , describes the plight of her mother in a hospital after she was diagnosed with cancer of the small intestine, and her suffering during the process of treatment. They feared even more than dying, what some call “death by intensive care”. Such fears are rarely shared among healthcare professionals, elderly people or their family members because medical etiquette discourages it.

Many elderly people and their children want aggressive treatment, advanced tests, and the latest remedies — which may not really enhance the quality of life. Everything that can be done will be done in a major hospital, whether it is necessary or not, of course at a cost. Patients may fall into an endless loop of irrevocable conditions, extending their suffering.

A privilege denied Every human being yearns for a peaceful death. People who are terminally ill or bed-ridden at least expect a dignified death, but most of them are denied that privilege owing to certain misconceptions. People should be made aware of the real situation.

After I became a volunteer with a najor palliative care organisation, I came to know of the possibility of giving empathetic treatment to patients and the concept of spending one's final days largely at peace with oneself and then dying with dignity.

A lucky escape I used to share the experiences with my dad. He often told me it is the right of every human being to choose a dignified mode of death. He neither wrote down nor conveyed this message to anybody else. So to take a decision overruling surgery for his third- stage brain tumour at the age of 83 was difficult. He was lucky to escape the trauma of surgery.

Everybody may not be so lucky. So from my personal experience, I suggest that people set down on paper their well-considered preferences with regard to the kind of treatment that should be given to him/her in case they become at some point too incapacitated to take a decision and express it.

To aid a decision This will make it easier for their children, caregivers and relatives to take a decision on their behalf. (In some countries other than in India, an ‘advance directive’ is a document by which a person makes provision for health care decisions in the event that he/she becomes unable to make those decisions at a point in the future. There are two main types of advance directives — the “living will”, and the “durable power of attorney for health care”.)

I have seen poor and terminally ill patients coming to the palliative clinic as a last resort after exhausting all their energy and money for surgery, radiation, chemotherapy and so on. I came across one patient in unbearable pain. Her husband, a daily wage labourer, explained to me that the doctors had said her cancer was incurable but still she was operated upon, beyond affordability.

Palliative option She should have been sent to a palliative clinic to avoid the distress caused physically and monetarily.

The leg of another woman in her 80s who was in coma was amputated, citing an infection in her leg. She lived for just another week.

Why is such cruelty meted out to an imminently departing soul? There are innumerable cases like this. Why cannot the doctors refer them to palliative care? Palliative care is not just the last resort. It is wholesome care given to patients after considering the severity, age, futility of the available treatment options, and so on. It gives solace to suffering patients and paves the way for one to leave this world with dignity.

It is true that we cannot always fully control the disease and pain of our loved ones, but we can certainly mitigate their level of pain through palliative care options.

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