There’s an urgent need to initiate a dialogue on end-of-life care for terminally-ill patients so that we can adopt a more humane approach to the inevitability of death.

Dying is an inevitable part of life. Everybody aspires to live a long life and die a painless death. Yet, many of us have seen a lot of pain, suffering, and loneliness associated with the end of life. Today, as more people die of chronic diseases, the average person can expect to spend the last decade of /her life being seriously ill and under constant medical treatment. That’s the downside of extended lifespan – the life expectancy in 1960 was 40 years, today it is 72 years!

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Quality vs. quantity

Studies have shown that end-of-life medical interventions are largely unnecessary and ineffective. Among all those who die in hospitals, 1/3rd are in ICUs and 1/5th have undergone redundant operations in the last month of their lives.

Treatments for terminal illnesses are non-curative by definition and so are likely to result in relatively small health gains when compared to other types of treatment. Such health gains often come at a high cost – less likely to meet the cost-effectiveness threshold.

Recent research shows that pain relief, quality care, interaction with family, near and dear ones are equally important – if not more than the treatment itself during the end of life. However, Indian society places special value on treatments that prolong life – even for a few months – near the end of life.

Prolonging life at any cost, getting terminally-ill patients into and out of hospitals, with no value assigned to patient’s preferences for pain relief and healthy family interactions diminishes his/her quality of life. Living in fear of a long, drawn-out, unpleasant, awful death takes away from the quality of life. We need to find a balance between quality of life and prolonged life.

End-of-life care

The relative value of life extensions for people with terminal illnesses, like cancer, needs to be addressed with a holistic perspective rather than the single motto of extending life at any cost. All end-of-life major treatments for such patients need to consider cost per Quality-Adjusted Life Year (QALY) before deployment.

Historically, indigenous cultures encouraged the use of psilocybin and other hallucinogens as part of treating dying patients. Today, there is a wide variety of medicines available to help decrease depression and anxiety, reduce pain, and improve the quality of life in patients with life-threatening illnesses.

End-of-life treatment should focus on palliative care. Issues like patients’ physical comfort, pain relief, daily care, and emotional and spiritual health are key ingredients of treatment.

The medical fraternity has to listen to patients’ interests and needs. There’s an urgent need to initiate a dialogue on the subject so that we can adopt a more humane approach to the inevitability of death.

(The author is a principal scientist with ICAR-Centre Research Institute for Dryland Agriculture, Hyderabad, India.)