A response to: The gift of death
The recently-out and much talked about report published in Lancet Commission report: bringing death back into life, talks about a global paradigm about how people die. While many people are dying an overly-medicalized death in an intensive care unit, many unfortunates do not even get basic health services, die of a preventable cause and keep on suffering till their last breath. India is witness to both the extremes.
As you state in your opinion piece, the rich and the privileged are getting high-tech medicalized care almost equivalent to that available in affluent countries. They are living longer, with better quality of life and access to state-of-the-art medical care. The other end of the spectrum has the poor, forgotten people of this beautiful land, who die of tuberculosis, pneumonia, undernutrition, and drowning. Having limited access to primary health care, and non-existent secondary and tertiary level care leads to unpardonable delay in diagnosis and management and lives are lost by the clock. The inequity in health is most unbearable and monstrous.
I work in the most ‘backward’ of areas in terms of access to quality healthcare. The residents of this state are mostly tribal people, who live on hilltops and rely on forest products for their living. Needless to say, palliative care is an alien concept here. In my practice I see this paradigm every day. Symptoms are noted late. Local healers are the first point of contact for care-seeking. Doctors are often not well trained and lack motivation. Diagnosis process is lengthy and expensive. And quality management is not available anywhere within a 350 km radius.
How do we place these deaths? How do we justify these immense sufferings and indignity? How do you improve the quality of death without addressing quality of life? How do you provide palliative care when you see people are dying prematurely and unnecessarily? How do you integrate palliative care in a health system which is not supported by quality and accessible secondary and tertiary levels of care? How do you improve quality of life in a community where the loss of productivity literally means a death sentence?
While we should look at rationalizing care at the end of life, we should not forget how we have left millions without any rational and quality healthcare.
Competing interests: No competing interests
23 February 2022
Shilpa Khanna, Pain relief and Palliative care provider and Anaesthesiologist;
Sangwari-People’s Association for Equity and Health,
Ambikapur, Chhattisgarh, India-497001