A DIRE NEED FOR PALLIATIVE CARE

 https://www.pakistantoday.com.pk/2021/10/02/the-dire-need-for-palliative-care/

It is time morphine was made available in hospitals for pain relief

“All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private.”

Paul Kallanithi

Hospitals in Pakistan cater to most fields of medicine, cardiology, oncology, rheumatology, gastroenterology, but the crucial field of palliative care is sorely neglected, in fact it barely exists. It is said that the ratio of palliative services to population in Pakistan is 1:90 million, which is a staggeringly woeful picture.

What is palliative care?

Palliative care is the help offered to a patient when his or her disease no longer responds to curative treatment, in other words at a ‘terminal’ stage, where the disease is considered likely to lead to death. That is when palliative care and hospices are required.

Of all other fields of medicine, palliative care is the one that caters most holistically to a patient.

Palliative care includes non-medical care for the dying person, it caters to a person’s physical as well as emotional needs, such as providing religious facilities where required, addressing the patient and his family’s questions and concerns, and generally making that period of life as easy as possible.

Palliative care takes into account a person’s quality of life, and works towards making death as peaceful, as dignified and as painless as possible.

At a certain stage, such care is ideally provided in the patient’s home, when the role of the family takes on even greater importance, but that depends on the individual situation. In a poverty-stricken country like Pakistan this might not always be possible, therefore adequate facilities must be available in hospitals, and professional training, equipment, and personnel provided.

There are the usual set of people who say that death is not the concern of hospitals and medical professionals. Those are generally the people who also say that since it is God who determines the manner of death, everyone else should stay out of the matter. Again, these are generally the same people who fail to rationalize religion, who in fact imagine that reason contradicts faith.

God is certainly the one who determines the manner of death. However, if humans must stay out of that matter, then we should all also stop taking medications and going in for surgery, since ‘all of medicine trespasses into sacred spheres,’ yet no one expects this.

There are other misconceptions.

Palliative care is sometimes confused with euthanasia, when in fact these are two very different things. Euthanasia is the practice of actively ending a person’s life to minimize suffering. Palliative care does not end life, it strives to make the living easier and the ending – when it comes, less difficult.

Paul Kalanithi, an American neurosurgeon who opted to work in palliative care until he himself died of metastatic lung cancer, was 37 at the time of his death. His book on this subject, When Breath Becomes Air, is worth a read. Obviously, after a certain point Paul was unable to write himself, and then the tale was taken up by his wife. One of the most remarkable features of the book is her description of the way Paul dies. The quote at the head of this piece is taken from this book.

One of the most important requirements of palliative care is morphine, which is used to minimize pain and help the dying person move forward with the least possible suffering. Unfortunately, that is another misconception, that allowing morphine into mainstream medical care is the same as encouraging drug addiction. That is highly incorrect. To equate the two is like equating breathing polluted air with suicide. You need to prevent pollution, which would minimize deaths related to it. In the same way, the manner in which morphine is dispensed needs to be controlled, to prevent it from falling into the wrong hands.

Morphine, a crucial narcotic, is not available in Pakistan. At least not legally, not even in hospitals.

Morphine is an extract derived from the opium plant. Also made from the opium plant is heroin, which is used as an addictive substance.

It is time morphine was made available in hospitals for pain relief.

Afghanistan is the world’s largest producer of opium. Its opium harvest accounts for 80 percent of the world supply. So now, instead of simply batting our eyes at the new Taliban leadership, authorities in Pakistan should look at importing opium, the most abundant and useful commodity produced in their country, instead of importing the Taliban brand of religion. And then to use this opium to make morphine, to help all who need this narcotic in this country.

Palliative care is probably a difficult concept for our authorities to understand, the fact of making death easy for its people, when they seem to find it so difficult to make it easy for them to live, but it is well to remember that we all have to experience death, which is an integral aspect of life, and not all of us can be airlifted to another country and treated in foreign hospitals when the time comes.