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June 2012
Palliative Care: Affirming Life In Terminal Illness
Dr Arundhati Chakraborty
By one simple and straight definition, palliative care is the medical discipline that deals with the last phase of life. To elaborate it in medical parlance, it is the treatment and care of patients for whom the prognosis is limited.

The emphasis of treatment is on earning for the individual patient as best a quality of life that may be managed within the constraints of her/his disease/illness.

Needless to say then, palliative care is unique when tallied against the grain of medicine where the doctor shall seek to cure, preserve and prolong life. So, who are the patients that you will normally see in palliative care? People with advanced cancer, those afflicted by AIDS and Motor Neuron diseases, people with terminal stage cardiac and renal diseases are some of them.

Palliative Care Works On The Following Principles
  • You shall seek to provide the patient relief from pain and other distressing symptoms.
  • You shall affirm life and regard dying as a normal process.
  • Your intention is to offer care and relief and there is nothing about seeking to hasten death or to postpone it.
  • You shall specially integrate patient care with psychological and spiritual aspects.You shall be a support system helping the patient in your care to live as actively as possible until death.
  • You shall be a support system to the patient’s family during the illness and when the family is eventually called to cope with bereavement.
  • You shall use a team approach to address the needs of the patient and his/her family.
  • You shall enhance the quality of life and bring in a positive influence on the course of the patient’s illness.
Origin And Establishment As A Medical Speciality
Palliative Medicine has taken roots from the concept of hospices that has been prevalent since ancient times. The word “hospes” means “guest or visitor”. By origin, hospices welcomed and sheltered pilgrims. The latter belonged to the category of pilgrims who often looked battered and close to dying on arrival. Hospices not only offered them food and drink but also cared and treated their sickness.

In the 1960s, Dame Cicely Saunders became the pioneer of hospice movement in UK. This led to the development of numerous hospices throughout the world. The University of Wales in Cardiff started a Diploma course in Palliative Medicine in 1992. This was followed by training programmes in many universities all over the world.

Palliative Medicine In India
The concept of Palliative Medicine arrived in India in 1993 when the Union Ministry of Health took an initiative upon the insistence of Dr Jan Stjernsward the then chief of WHO’s Cancer and Palliative Care Centre. India received from the WHO free supply of Oral Morphine for use in pain Symptom Control Disease Management Psychosocial Care management in cancer patients. The Indian Association of Palliative Care was formed in 1994. An increase in the awareness about palliative care is observed these days. Currently there are about 66 Palliative Care units across the country; the state of Kerala leads with 36 units.

The Future Of Palliative Medicine
India sorely lacks a national policy on Palliative Care. WHO recommends remedial actions based on the following three points: Governmental policy, education and the availability of drugs.
Dr Arundhati Chakraborty Head Department of Radiation Oncology, Apollo Gleneagles Hospitals, Kolkata.

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