In its consensus position statement just published in the September-December 2014 issue of the Indian Journal of Palliative Care, the Indian Association of Palliative Care (IAPC) has asserted that access to palliative care and end of life care is a human right and that all patients are entitled to a dignified death. It has vowed to involve all stakeholders and create the right environment to develop a nationwide uniform policy for end of life care.

IAPC hopes that such a policy would pave the way for clinical excellence in the care for the dying, facilitate standard and scientific care processes, encourage research and development and, above all, provide a human touch to patients in the crucial phase of life’s journey.

Based on a review of country reports, observational studies and important surveys, the statement concludes that end of life care (EOLC) is delivered ineffectively in India.

The paper laments that the culture of medical practice in India is “generally paternalistic with little consideration for the patient’s autonomy and respect for the patient’s choices.” Physicians in India are reluctant to consider limitation of life support primarily due to the lack of a clear legal framework on this issue. Medical education, founded on the “acute model of care”, has not kept pace with the changing pattern and trajectory of illness. Ignorance of chronic care and palliative care has led to the inappropriate, acute treatment of end of life patients.

In its recommendations, IAPC has requested the government to enact the “Medical treatment to terminally ill patients (Protection of patients and medical practitioners) Bill, 2006” in order to facilitate the process of achieving a good death.

Also, the government should make EOLC training an integral part of undergraduate and postgraduate curriculum for medical, nursing and allied health streams. All doctors and nurses involved in direct patient care should undergo mandatory EOLC training and certification.

There is a need for a comprehensive care process that minimises physical and non-physical symptoms at end of life and ensures access to essential medicines for pain and symptom control, the paper has stated. Palliative care and EOLC ought to become a part of all hospital and community- or home-based healthcare programmes.

The position paper recommends that appropriate authorities establish standards of palliative care and EOLC, which must be monitored by national accreditation boards. On its part, IAPC proposes to create guidelines, algorithms, manuals, toolkits and standard forms to ensure quality care is provided for all at end of life.

Please access the full position paper here.

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