Volume 2 - Issue 3 (May-Jul)

From the Editor-in-chief
The solution is to train community volunteers and to empower them to avail the help of nurses, doctors and
hospices. They can be trained by medical personnel and they can be given access to any other information through
toll free numbers, free on-line training, open access websites and periodic free training at the cost of the NGOs
and government. Even small things like daily visits, emotional support, spiritual counseling, basic patient care
techniques like how to avoid bedsores, advising a suitable diet within the means of the patient, awareness of the
difference between communicable and noncommunicable diseases can help the patient greatly during the last few
days of their life.
One question the care-giver has to face all the time from the patient is “How long will I live?’’. Let us leave all the
mercy and mental agony issues aside and handle this question in a more pragmatic manner. No medical or nonmedical
person can exactly specify when and at what time the patient is likely to die. But patients may have some
goals like settling their properties in the way they choose or seeing their daughters or sons married before they die
etc. Such expectations are not unreasonable and hence the palliative care-giver can clearly inform the patients to
expedite matters on their wishes. Another issue that always hampers the palliative care giver is the pressure of the
close relatives not to tell the patient that the end is nearing. A fair analogy is if I were to be given some money
and am allowed to spend it, without being told only the last few rupees are remaining, will I consider that as fair?
It is always better if we know when we are nearing the end of our resources. So it is more merciful if the patients
were told that their end is nearing. Probably such information will cause a few upset moments.But everyone
knows that when there is birth, there is death. So they will come to terms with it and handle it better.By not
revealing that, we may actually do injustice to the patient. Because he/she might want to speak to certain friends
and relatives, express his/her opinions, concerns and fears better before the end. Another aspect of this revelation
is that the patients may choose not to waste their meagre resources any further on treatments and medicines. If
a person has worked for 20 years earning money for the marriage of his/her daughter, then it is not logical to
let them spend it when the care giver surely knows the outcome. The trouble with concealment is that one can
quite easily drift into deception. I feel minimal levels of wisdom and massive doses of idealism probably lead the
medical professional to adapt this well meaning deceit and frank injustice to the patient. That logic is as circular
as a Mobius strip where an ant can traverse the entire strip without touching edge anywhere. I would welcome
guidance on this multi-faceted issue from the well informed. It is the province of the knowledge to speak and it
is the privilege of wisdom to listen. Now it is time for the readers to speak their mind.
Best wishes.
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Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012