Volume 2 - Issue 3 (May-Jul)

From the Editor’s desk
From the Editor-in-chief
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Dr KMK Masthan
Professor and Head,
Department of Oral Pathology and Microbiology
Sree Balaji Dental College and Hospital
Chennai
My editorial in the previous issue on academics and research elicited a mixed response ranging from
strong criticisms to “You are stepping on my toes” to surprising applause. My only response to all of
them is what Somerset Maugham once said “It is very hard to be a gentleman and a writer”. In this
issue I write about palliative care since, I was a witness to one patient’s final moments last month. I felt his last
days would have been better if he had received some form of palliative care instead of the well meaning deceit of
his relatives who kept telling him that he was going to get better. Hence, I share what feel about such care with
the readers.
Palliative care is the care given to the dying, encompassing physical, psychological, social and spiritual
dimensions. It is not the efforts of the medical profession alone, but includes the family members and the
society. This is not some thing new and was practised by King Asoka twenty-four centuries back. He had
installed several hospices to attend to the needs of the dying with special care and attention. All countries
face the rapidly increasing burden of patients nearing their end due to cardiovascular disorders, cancers,
diabetes, respiratory diseases, neurological disabilities and psychiatric ailments. In our country especially, certain
factors like extreme changes in lifestyle during the past four decades have brought about higher incidence of
hypertension, diabetes mellitus, cancers due to tobacco chewing and smoking and coronary artery disease due to
junk/fatty food and hence more number of patients facing premature death.
Whereas, we, as Indians, pride ourselves to be more spiritual and religious, the reality is our dying
elders do not get the dignity due to them and the rightful care they deserve. Busy life, mind set, financial
obligations, poverty, trend towards abolition of joint families all contribute to this insensitivity on the part of the
family members and so the due palliative care is not provided to the dying. Another factor that must be mentioned
is the present medical care system including paid hospitals is more geared to cures and alleviation rather than
support and care. The governmental medical care is totally oblivious and frankly resistant to this palliation concept
at all, the common instruction to the patient’s relative being “Take the patient home’’.
In palliative care, most care givers are faced with situations that have obvious solutions, but unsuitable for the
recipient. For example, whether to advise cardio-pulmonary resuscitation for a patient under palliative care. For
a normal person whose heart has failed due to heart attack or electric shock, it is a life saving procedure. But for
a person who is expected to succumb to his/her disease in a few days, is it justified to subject them to this? My
opinion is a definite ‘No’.
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012
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