Death literacy need of the hour, says M.R. Rajagopal
Dr. M.R. Rajagopal delivering the eighth edition of Dr. T.K. Ramachandran Memorial Lecture on ‘Let us Change the Ending – Insights on Death, Dying and Medical Directives’ in Kochi on Monday.
| Photo Credit: R.K. Nithin
Dr. M.R. Rajagopal, anesthesiologist and Chairman Emeritus of Pallium India who pioneered palliative care in Kerala back in 1993 by setting up Pain and Palliative Care Society, said death literacy is the need of the hour as various factors still limit comfortable death for most people.
He was delivering the eighth edition of Dr. T.K. Ramachandran Memorial Lecture on ‘Let us Change the Ending – Insights on Death, Dying and Medical Directives’ here on Monday. “Withdrawing artificial life support is not mercy killing. Unfortunately, while around 90% of artificial life support systems are withdrawn in Europe when a reasonable recovery is proven impossible and end of life is certain, in India, it is still only 30%. So, as Dr. Sankha Mitra said, here, the poor die in misery of neglect, the middle class die in misery of ignorance, the rich die in misery on ventilators, and no one gets a pain-free and dignified death,” he said.
At the end of life, comfort is the most important factor and thus, treatment of pain and other physical symptoms should be taken care of while avoiding needless illness-related procedures, unnecessary use of antibiotics and hospitalisations, especially in ICU/CCU. Surgery, radiation, or chemotherapy are also to be avoided unless necessary for pain relief. Even feeding tubes are not called for unless already in place or the person is hungry yet unable to swallow, he said. Instead, psycho-socio-spiritual support, including listening to one’s stories without judging, validating feelings including grief, regrets and guilt and acknowledging achievements, is called for. “Sometimes just being there, in silence, is enough,” he said.
He also cited the Supreme Court’s 2023 judgment on Living Will and called it a common man’s protection against intensive torture. “If I sign a document expressing my wishes, and name a trusted person to take surrogate decisions, the doctors should have the ethical and legal duty to respect my wishes,” he added.
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