December 10, 2024 05:10 IST
First published: December 10, 2024 at 05:08 IST
Dying with dignity is one of the most pressing challenges we face today. A recent bill passed in the UK’s House of Commons highlights this concern. The cry of a section of its citizens echoes around the world, pleading for help in dying for themselves and their loved ones in the face of unbearable pain.
Statistics from Oregon — it was the first state to legalize assisted dying for the terminally ill in 1997 — show that two-thirds of those who sought help in dying last year had cancer. Not surprisingly, the main reasons patients seek this support are loss of dignity, fear of becoming a burden, inadequate pain control and the financial implications of continued treatment. Research published in JAMA Network Open found that among all cancer survivors, male adolescents and young adults (15-39) not only had a higher rate of suicide, but a three-fold increase in the rate. – Multiplied in recent years.
We have been grossly let down by our policymakers, legislators, administrators, medical institutions and physicians, the judicial and health systems, and society at large. The debate in the House of Commons brought these shortcomings into sharp focus with calls for further investment of government resources in palliative care. It is surprising to hear that in the UK, considered the mother of the modern hospice and palliative care movement, hospices have had to close because they depend mainly on charity funding. Accessible, affordable and compassionate palliative care can save many lives.
At CanSupport, we can testify to that. We have had some people with terminal cancer who had suicidal thoughts but once their problems were resolved, they not only continued to live well but they died with dignity. It achieves palliative care by focusing on the physical, psychosocial, spiritual and financial needs of patients and their caregivers.
However, this care is accessible to less than 4 percent of those who need it. It is largely provided by NGOs that suffer from a lack of funding and face many obstacles, especially in obtaining a license for oral morphine, the drug of choice for cancer pain. Our laws must also ensure that advance medical directives or living wills are implemented and followed.
Recently, India’s Supreme Court refused to allow the parents of a 30-year-old girl, who had been in a vegetative state for 11 years, to remove her feeding tube after suffering a head injury. The parents complained that they could no longer take care of their son. Such demands are not isolated and are symptomatic of our callous indifference to suffering.
When CanSupport heard about this family’s plight, our palliative care team visited them and discussed with the parents how best to care for their bedridden son, as well as answering questions that had never been addressed.
Based on our 28 years of experience caring for patients with severe health-related pain, there is no doubt in our minds that palliative care should be universally available and become part of the public health care system. With increasing non-communicable diseases and the prospect of an aging population, we must act now. We cannot ignore this aspect of care because now the dying is likely to become a chorus of isolated cries for help. It will be disastrous for India.
Unlike parts of the Western world, we are a highly stratified society. The potential abuse of the law on assisted dying, regardless of the railing, would be immense. Marginalized and vulnerable populations who are economically dependent on family members and the state are likely to be disproportionately affected. Developments in Canada following the legalization of Medical Assistance in Dying (MAID) testify to this.
Not only has MAID become a slippery slope, with calls now being made to include more segments of the population in its scope, but Canadian health workers believe that the provision of accessible and quality health services for the most vulnerable people is beginning to slip, pushing them away. In the direction of MAID. With this in mind, a coalition of disability rights organizations in Canada has filed a Charter challenge against so-called track two of the MAID law, which allows individuals to seek MAID even when death is not reasonably foreseeable. Also in the UK, the British Medical Association has voiced its opposition to legislation requiring doctors to assist their patients in suicide.
Palliative and hospice care provide tools to prevent serious health-related suffering. The question is, do we have the commitment and necessary foresight to use them with wisdom and compassion?
The author is the founding president of Cansport