End of Life Care with a Critical Care Specialist
The Importance of End of Life Care
In India, as in many parts of the world, the question of end of life care is one that people want to avoid thinking about. The end of a life is sad both for those who pass away and for those who are left behind. While nothing can be done to avoid the ultimate demise, much can be done to make it as peaceful and painless as possible.
In India alone, 1 million new cases of cancer are diagnosed every year. Of these, between 70 to 80% are at stage 4, where the treatment options are very limited. Of these stage 4 patients, over 60% suffer from pain and the rest endure severe pain. The unfortunate part of this is that in India, only 5% of these patients have access to palliative and end of life care. These terms are often misunderstood – they do not mean that recovery is possible, what they do mean is that they offer the difference between a good death and a bad one. It is important to understand the difference between the two.
A good death is one where the patient passes away peacefully, with no pain and in the presence of his or her loved ones, in comfortable surroundings, such as one’s home. A bad death is where the patient dies, perhaps alone and often in unbearable pain after having his or her life prolonged by aggressive and often dehumanizing care in an ICU. Far too many deaths in India fall into the second category because of a lack of knowledge about end of life care and confusion and fear of the prevalent laws in the country. An example of this is the recent death of a well-known police officer in Mumbai who committed suicide because of the depression caused by incurable cancer.
In India, there has been no concerted discussion on the right to die with dignity and with as much peace as possible. The subject is one that most people prefer to avoid and the result is that patients are given futile treatments that only manage symptoms with no hope of recovery. It is for this reason that the Indian Society of Critical Care Medicine has created a position statement on this matter. This states that in the case of terminally ill patients in the ICU, the focus should be on a shift from the system of paternalistic care that pointlessly prolongs suffering to one of a shared decision-based model when deciding on the objective of treating terminally ill patients.
If you have a loved one who is suffering from an incurable disease, think of the objective of the care being provided. Will it only prolong the suffering without offering any real benefits to the patient? Would it not be preferable to replace aggressive care with that which will make him or her more comfortable and provide more peace?
It is difficult, but for the patient’s sake, it will be better for both the patient and the family to discuss the option of palliative and end of life care with a critical care specialist to enable the patient’s life to end with peace and dignity.
Article by Dr. Susovan Mitra, MBBS, MD (Emergency Medicine) MEM, Dip. Emergency Medicine, Fellowship in Critical Care Medicine Consultant Intensivist, Kauvery Hospital