Palliative care is an integrated approach of treatment for terminally ill patients that improves their quality of life through lowering sufferings and relief of pain. But it is not just only the treatment of pain and disease related symptoms. It involves comprehensive care with physical improvement as well as psychological council.
Unfortunately appropriate way of delivering palliative care is not followed in many cases. Some caregivers do not pay proper attention to them as they think death is inevitable and there is nothing to do with them. In fact, there are many things to do. Although we can not prevent death, we can help prevent their painful demise. We can give them much comfort at the end of their life so that they die like a normal human being. We can ease the intractable pain; we can enhance the quality of life and even can prolong the life span in some cases. For all this, we need to approach in right way.
Some physicians may say his/her last statement to a terminally ill patient as “I am trying for you, we have nothing more available to improve your situation”. This type of statements may be uttered by any doctor for a dying patient aged or young when all known avenues of curative treatment are exhausted.
It is more disturbing, disheartening, disappointing than the truth embedded in the statement. Usually tears swell up in everyone’s eye after hearing such statement. Whatever the case may be, I personally believe that such statements should be framed in a different manner. I would rather say, “we have given you enough of costly and toxic treatments. But the benefit is not yet remarkable. You are now suffering from severe pain (and other symptoms according to nature of diseases). It is very important for me to try to relive from these symptoms and from now, we shall focus on better treatment. After your troubles are relieved, I shall try to consider other treatment. I am now searching through the Internet the world’s most up-to-date publications including this month to see whether any other effective treatment is discovered for your situation anywhere in the world. If you would like to discuss anything with me, please go ahead while I write new medicine for you.”
Usually the patient understands and realises. Sometimes not in the presence of the patient, the relatives may ask about the probable life span of the patients. I would say “No one can give a time table for death. I may give an indication like not more than 3 months or 6 months but please note that the religion does not allow any predictive statement to be pronounced by any human. It is totally an affair of the Almighty, who decides on these matters of life and death.”
Many doctors and specialists consider this as the fight against the inevitable, which is nothing but futile. They might increase the mental sufferings of the patients instead of relieving it. All doctors specially oncologists (cancer specialists) must learn the art of facing the foreseeable and must not be the cause iatrogenic (caused by human) futile and fruitless sufferings to the patients and his/her relatives.
The desire to die with dignity is cherished by everyone and should be considered as a human right for every dying patient.
Professor Dr A B M F Karim
Professor Emeritus and Former Chairman: Radiation Oncology, Vrije University Hospital at Amsterdam. He is presently an Advisor to Saarc Federation of Oncologists. Currently he holds then post of Chairman, Oncology Club and Editiorial Board of Cancer Control Journal in collaboration with Moffitt Cancer Center, USA.
Source: The Daily Star, February 13, 2010
