Pallium India
Care Beyond Cure
* ~~~~~~~~~~~ *
! August 2016 !
* ~~~~~~~~~~~ *
http://palliumindia.org/2016/07/august-2016/
July 31, 2016
DEAR FRIENDS,
"
“In India, the poor die in agony in neglect, the middle-class die in
agony in ignorance and the rich die in agony on a ventilator. No one gets a
dignified and pain-free death”,"
Dr Sankha Mitra is thus quoted in the article titled “ Saying good-bye
with dignity
[http://www.thehindu.com/opinion/open-page/saying-goodbye-with-dignity/article8808000.ece]
” published in _The Hindu_ DATED JULY 5, 2016.
THE ARTICLE DESCRIBES THE PATH OF PALLIATIVE CARE DEVELOPMENT IN INDIA,
THE INVOLVEMENT OF THE COMMUNITY AND THE ROLE PLAYED BY THE CENTRAL AND STATE
GOVERNMENTS. DESPITE CREATION OF A NATIONAL PROGRAM FOR PALLIATIVE CARE,
PROGRESS HAS BEEN SLOW DUE TO LACK OF BUDGET ALLOCATION AND PROFESSIONAL
EDUCATION. HOSPITALS STILL DO NOT STOCK AND DISPENSE MORPHINE, AND THE BASIC
PRINCIPLES OF MODERN PAIN MANAGEMENT ARE NOT BEING TAUGHT TO MEDICAL AND
NURSING STUDENTS.
Read the complete article here: Saying good-bye with dignity
[http://www.thehindu.com/opinion/open-page/saying-goodbye-with-dignity/article8808000.ece]
–
SIGN THE PETITION TO PROTECT OUR END OF LIFE WISHES
[HTTPS://WWW.CHANGE.ORG/P/MINISTRY-OF-HEALTH-AND-FAMILY-WELFARE-PROTECT-OUR-END-OF-LIFE-WISHES]
Death is the inevitable consequence of life. It will happen to you and
to me – regardless of who we are, where we are and how we live.
THIS PETITION IS APPLICABLE TO EACH ONE OF US. ACT BEFORE IT IS TOO
LATE.
Over 500 people have already signed this petition. If you haven’t done
so already, please sign now!
PROTECT OUR END OF LIFE WISHES
[https://www.change.org/p/ministry-of-health-and-family-welfare-protect-our-end-of-life-wishes]
This petition will be submitted to the Ministry of Health and Family
Welfare, Government of India, to protect our end of life wishes.
Please read the petition and sign (by entering your name and email) to
show your support. Pallium India will collect all the responses and forward it
to the Ministry of Health and Family Welfare, Government of India.
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END-OF-LIFE CARE ACROSS THE WORLD: A GLOBAL MORAL FAILING
[HTTP://PALLIUMINDIA.ORG/2016/07/END-OF-LIFE-CARE-ACROSS-THE-WORLD-A-GLOBAL-MORAL-FAILING/]
[http://palliumindia.org/2016/07/end-of-life-care-across-the-world-a-global-moral-failing/]
“Despite its limitations, the 2015 Quality of Death index is an insightful and
credible effort that laudably calls attention to the woefully inadequate care
for some of the neediest and most vulnerable patients across the world, those
nearing the end of life,” say Dr Eric Krakauer (Harvard Medical School) and Dr
M R Rajagopal (Pallium India), evaluating the Economist Intelligence Unit’s
2015 report [http://palliumindia.org/2015/10/frightening/] in the Lancet ;
(Volume 388, 30 July 2016)
[http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31133-3.pdf] .
The report in the Lancet points out that though the top 27 overall
scorers are high income countries, low middle income Mongolia (No.28) and low
income Uganda (No. 35) are doing much better than the high income Russia
(No.48) and Saudi Arabia (No.60). Much too often, lack of finances is pointed
out as an excuse for not offering palliative care as in India (No. 67) and
hence the authors have done well to point out the inequity.
The report points out the several limitations of the study. Yet that is
the best index we have so far and as the authors exhort, “Public Health
organizations, global health funders and political, economic and health care
leaders should attend carefully to it.”
Read the article in the Lancet: End-of-life care across the world: a
global moral failing
[http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31133-3.pdf]
–
MORE VOICES IN SUPPORT OF PALLIATIVE CARE AND ALLOWING NATURAL DEATH
[HTTP://PALLIUMINDIA.ORG/2016/07/MORE-VOICES-IN-SUPPORT-OF-PALLIATIVE-CARE-AND-ALLOWING-NATURAL-DEATH/]
Please listen to what Dr Jochen Beker-Ebel has to say
[http://timesofindia.indiatimes.com/city/bengaluru/India-needs-palliative-care-policy-Expert/articleshow/53274980.cms]
. In Germany, access to palliative care, a human right, has been assured by
law as far back as twenty years ago. Let us remember his statement,
“Implementation of a palliative care policy would reduce their desire for an
early death.”
Read the news in the _Times of India_
[http://timesofindia.indiatimes.com/city/bengaluru/India-needs-palliative-care-policy-Expert/articleshow/53274980.cms]
.
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GANGA PREM HOSPICE, RISHIKESH, INVITES APPLICATIONS FROM PALLIATIVE CARE
DOCTORS
[HTTP://PALLIUMINDIA.ORG/2016/07/GANGA-PREM-HOSPICE-RISHIKESH-INVITES-APPLICATIONS-FROM-PALLIATIVE-CARE-DOCTORS/]
[http://palliumindia.org/2016/07/ganga-prem-hospice-rishikesh-invites-applications-from-palliative-care-doctors/]
Ganga Prem Hospice, Rishikesh, Uttarakhand, invites applications from
trained palliative care professionals to join its team as a full time
Palliative Care Doctor.
Ganga Prem Hospice is a spiritually oriented, non-profit hospice for
terminally ill cancer patients which currently offers home care to the
districts of Rishikesh, Haridwar and Dehradun in Uttarakhand, North India.
The Hospice provides medical, social, emotional and spiritual support
for individuals and their loved ones facing life threatening diseases.
A new inpatient unit at Ganga Prem Hospice is due to open by the end of
2016.
For more details on the hospice and the vacancy, please click here
[http://palliumindia.org/cms/wp-content/uploads/2016/07/Ganga-Prem-Hospice-Rishikesh.pdf]
.
Contact: info@xxxxxxxxxxxxxxxxxxxx [mailto:info@xxxxxxxxxxxxxxxxxxxx] / ;
91-9810931743
_For more openings, visit our __ Careers
[http://palliumindia.org/about/careers/] page._ ;
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OPIOID WORKSHOP HELD IN NAGPUR
[HTTP://PALLIUMINDIA.ORG/2016/07/OPIOID-WORKSHOP-HELD-IN-NAGPUR/]
[http://palliumindia.org/2016/07/opioid-workshop-held-in-nagpur/] ;
An opioid workshop was organised in Nagpur by NKPSIMS & RH & Lata
Mangeshakar Hospital, Digdoh on 8th July 2016. It was attended by about 70
delegates including doctors, nurses administrators and medical social workers.
The purpose of the workshop was to highlight the vital role and safety
of opioids – chiefly Injection and Tablets Morphine in managing pain and
palliative care – as well as to make the delegates aware of the NDPS (Narcotic
Drugs and Psychotropic Substances) Act of India and its recent Amendment.
The speakers included Dr Nandini Vallath, consultant of Pallium India,
Dr Chandrashekhar Cham, well known senior anaesthesiologist and pain management
consultant of Nagpur, Mr M. G. Kekatpure, the Joint commissioner of the
department of FDA (Food and Drug Administration) Nagpur and Mr V.R. Ravi, drug
inspector, FDA Nagpur. The event was also graced by the presence of Honourable
Secretary VSPM Academy of Health and Education, Nagpur, Dr Amol Deshmukh, the
Dean of NKPSIMS & LMH, Dr Kajal Mitra, Medical Superintendent, Dr Milind
Bhrushundi and Professor and H.O.D. Forensic Medicine LMH, Dr Kanade, Professor
and H.O.D. of Surgery, Dr Murtaza Akhtar, and many others.
The legal issues and commonly unknown facts concerning opioids, such as
their cultivation, transport, formulations and the provisions and punishments
mentioned in the NDPS act were discussed, as well as the NDPS amendment of 2014
which has made the process of procuring, storing and using the opioids, notably
Morphine, simple and uniform for all states of India.
Read the complete report of the workshop
[http://palliumindia.org/cms/wp-content/uploads/2016/07/Nagpur-Opioid-Workshop-July-2016.pdf]
, prepared by Dr Ravindra Kshirsagar, Lecturer in Medicine and palliative care
physician of LMH.
–
END OF LIFE CARE WORKSHOP IN DELHI
[HTTP://PALLIUMINDIA.ORG/2016/07/END-OF-LIFE-CARE-WORKSHOP-IN-DELHI/]
[http://palliumindia.org/2016/07/end-of-life-care-workshop-in-delhi/] ;
Dr Nandini Vallath, Pallium India’s consultant, writes: "
“Law is codified common sense.” This is the sentence that remains
uppermost in my mind when I think of the meeting on end of life care and law,
held at the Taj Vivanta in Dwarka, Delhi, on the 10th of July 2016. The meeting
was organised through the collaborative efforts of three professional bodies –
Indian Association of Neurology, Indian Association of Palliative Care and the
Indian Association of Critical Care Medicine."
In an event beautifully conducted by Dr Roop Gursahani, attendees
including medical professionals, lawyers, media and the public discussed the
draft law brought up by the government of India. The discussions were grouped
under the following themes:
* PANEL 1 – DISCUSSED ‘PATIENT PERSPECTIVES’
Panelists: Harmala Gupta, Priya Jain, Nagesh Simha, Ajit Mansingh
The certainty of death and the importance of anticipating it were discussed by
this panel. Several members of the audience shared personal stories that
revealed the gaps and questioned the humane factor of care that is missing in
the hospital culture.
* PANEL 2 – THE DOCTOR’S PERSPECTIVES
Panelists: Raj Mani, Shivakumar Iyer, Sushma Bhatnagar, Sanjay Nagral
This panel discussed the relevance of the law within the current context of
inappropriate and disproportionate interventions using biomedical technology.
The alarming concerns on distressful, terrifying deaths were brought out and
the audience contributed actively through sharing of personal experiences.
* PANEL 3 – IMPORTANCE OF SOCIAL MOBILIZATION
Nandini Vallath, Anita Anand, Apoorva Pauranik, Vinita Singh
The Kerala experience of community mobilization was shared along with lessons
from the campaign on constitutional rights. The idea of organizing a public
campaign for living will was discussed with strategies to develop awareness
amongst the masses from all walks of life in India.
* PANEL 3 – THE RELATED LEGAL ANGLES
Girish Gokhale, Vivek Diwan, Nausher Kohli
Eminent lawyers emphasized the relevance of the law as the right of every
citizen of India for regulating her/his own treatment and choose to ensure a
dignified exit from life. Legalities of traditional practices such as
Sallekhana too, came up in the discussions.
–
ETHICS OF RESEARCH [HTTP://PALLIUMINDIA.ORG/2016/07/ETHICS-OF-RESEARCH/]
[http://palliumindia.org/2016/07/ethics-of-research/] “It is precisely ;
because we are a poor country that we cannot afford not to do research,” said
Jawaharlal Nehru. So meaningful. Do we really know what exactly are the issues
adversely affecting the quality of life of the villager from U.P admitted to
the Sufderjung hospital in Delhi with advanced cancer? And of his family? And
do we really know what interventions are the best for them?
But in the context of medicine, research is a bad word in India now.
Human beings were subjected to such unethical experimentation that the Supreme
Court asked, “Are Indians all Guinea pigs?” There has been a backlash.
On 15 July 2015, ethicists and researchers got together with clinicians
in Pallium India’s Trivandrum Institute of Palliative Sciences (TIPS) for a day
of learning on ethics of research. We thank the faculty members, Dr Mala
Ramanathan and Dr Anoop Kumar Thekkuveettil, and the Institutional ethics
committee of TIPS led by its chairman Justice M. R. Hariharan Nair.
–
CHEFS ON WHEELS! [HTTP://PALLIUMINDIA.ORG/2016/07/CHEFS-ON-WHEELS/]
[http://palliumindia.org/2016/07/chefs-on-wheels/] Pallium India’s
half-way home for people with spinal cord injury helps in physical, social and
psychological rehabilitation. One of our aims is to help them to be as
independent as possible and to contribute to society.
Thanks to Institute of Hotel Management and Catering (IHMCT), Kovalam,
they got a free catering course over several weeks. They have just graduated as
chefs!
We shall come back to you with more news when they actually start
working.
BEST WISHES, SAMEER, SHIJU, GOPIKA AND PRIYA!
–
HEALTH COULD SOON BECOME A FUNDAMENTAL RIGHT
[HTTP://TIMESOFINDIA.INDIATIMES.COM/INDIA/HEALTH-COULD-SOON-BECOME-A-FUNDAMENTAL-RIGHT/ARTICLESHOW/53371540.CMS]
NEW DELHI: Health may soon be declared a fundamental right of every
individual, similar to education, if the draft National Health Policy proposed
by the ministry goes through. Pending for nearly two years, the draft is
expected to be sent to the Cabinet early next month, official sources said.
“We have already circulated a Cabinet note. It should be placed before
the Cabinet in another week or 10 days,” a senior health ministry official told
TOI. The ministry had held several rounds of discussions with stakeholders,
including states and other government departments, and consensus had been built
on its proposals, he added.
Among various proposals, the draft policy advocates a National Health
Rights Act, which will make “denial of health” an offence.
Continue reading->
[http://timesofindia.indiatimes.com/india/Health-could-soon-become-a-fundamental-right/articleshow/53371540.cms]
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KARNATAKA TO GET ITS OWN POLICY ON PALLIATIVE CARE
[HTTP://TIMESOFINDIA.INDIATIMES.COM/CITY/BENGALURU/KARNATAKA-TO-GET-ITS-OWN-POLICY-ON-PALLIATIVE-CARE-IN-TWO-WEEKS/ARTICLESHOW/53293734.CMS?FROM=MDR]
Bengaluru: While the nation debates the right to passive euthanasia,
Karnataka is all set to get its first palliative care policy in about two
weeks. The policy will ensure terminally ill patients in the state mandatorily
get all-round care. Teams of dedicated doctors and volunteers will ensure such
patients have access to complete care — physical, psychological, social and
spiritual — in the last days of their lives.
Karnataka will be the third state in the country, after Maharashtra and
Kerala, to get a palliative care policy of its own. Experts say this is a
better alternative to euthanasia, whether passive or active.
Continue reading->
[http://timesofindia.indiatimes.com/city/bengaluru/karnataka-to-get-its-own-policy-on-palliative-care-in-two-weeks/articleshow/53293734.cms?from=mdr]
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PALLIATIVE CARE: KIDWAI TO START KARNATAKA’S 1ST MD COURSE
[HTTP://TIMESOFINDIA.INDIATIMES.COM/CITY/BENGALURU/PALLIATIVE-CARE-KIDWAI-TO-START-KARNATAKAS-1ST-MD-COURSE/ARTICLESHOW/53458293.CMS]
Bengaluru: Karnataka is all set to get its first MD course in
palliative care from the next academic year following the introduction of the
state’s palliative care policy in a few days. The three-year course at the
Rajiv Gandhi University of Health Sciences (RGUHS) will run at the Kidwai
Memorial Institute of Oncology here.
After Tata Memorial Centre, Mumbai and All-India Institute of Medical
Sciences, Delhi, Kidwai hospital will be the third institution to offer MD in
palliative medicine.
Continue reading->
[http://timesofindia.indiatimes.com/city/bengaluru/Palliative-care-Kidwai-to-start-Karnatakas-1st-MD-course/articleshow/53458293.cms]
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IMPROVING ACCESS TO END-OF-LIFE CARE
[HTTP://WWW.THEHINDU.COM/OPINION/OP-ED/RAMANAN-LAXMINARAYAN-COLUMN-ON-IMPROVING-ACCESS-TO-ENDOFLIFE-CARE/ARTICLE8829188.ECE]
One of my favourite aunts passed away very recently. She had lived a
long and gratifying life. In her early eighties, she was diagnosed with
dementia. Fortunately, her children, grandchildren and long-term maid took
loving care of her in her last decade. By the time she passed away in her home,
she could recognise only the few people who were closest to her. The last years
of her life were not only filled with attention and love but also with the deep
and frustrating challenges of not being able to care for herself.
My aunt was lucky. Most people in their twilight years would consider
themselves blessed to not have to worry about the financial costs of
end-of-life care, to have a family that could access health information on the
Internet or from medical journals to manage their condition, and access to
treatment by the best doctors. They would be fortunate to not be on expensive
medical equipment and drugs that lower their quality of life, and to die
without significant pain.
Continue reading->
[http://www.thehindu.com/opinion/op-ed/ramanan-laxminarayan-column-on-improving-access-to-endoflife-care/article8829188.ece]
–
DAVID OLIVER: END OF LIFE CARE IN HOSPITAL IS EVERYONE’S BUSINESS
[HTTP://WWW.BMJ.COM/CONTENT/354/BMJ.I3888]
Palliative care: do we need more specialist clinicians, or more
generalist staff better trained in it? My answer is both.
About 500 000 people die each year in England and Wales. Yet the United
Kingdom has only an estimated 519 specialist palliative medicine consultants
and fewer than 5000 crucial specialist palliative care nurses. A national audit
of end of life care in hospital by the Royal College of Physicians found a
median of one palliative medicine consultant and five nurse specialists for
every 1000 adult hospital beds.
Some of us will die suddenly. Others may have only weeks to prepare
after an unexpected terminal diagnosis, but most will die with or from long
term conditions. Multiple contacts with health and care practitioners give us
many opportunities to discuss and plan for our deaths.
Continue reading-> [http://www.bmj.com/content/354/bmj.i3888] ;
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PALLIATIVE CARE: THE OTHER OPIOID ISSUE
[HTTP://WWW.NATURE.COM/NATURE/JOURNAL/V535/N7611_SUPP/FULL/535S16A.HTML?WT.EC_ID=NATURE-20160715&SPMAILINGID=51828243&SPUSERID=MJA1NZCWMJE4MQS2&SPJOBID=961919509&SPREPORTID=OTYXOTE5NTA5S0]
When pharmacologist Ravindra Ghooi learned in 1996 that his mother had
terminal breast cancer, he began to investigate whether he could obtain
morphine, in case she needed pain relief at the end of her life. But a morphine
prescription in India at that time, even for the dying, was a rare thing: most
states required four or five different licences to buy painkillers such as
morphine, and there were harsh penalties for minor administrative errors. Few
pharmacies stocked opioids and it was a rare doctor who held the necessary
paperwork to prescribe them. Ghooi, who is now a consultant at Cipla Palliative
Care and Training Centre in Pune, used his connections to ask government and
industry officials if there was a straightforward way of obtaining morphine for
his mother. “Everybody agreed to give me morphine,” he recalls, “but they said
they’d give it to me illegally.”
Jim Cleary, an oncologist and palliative-care specialist at the
University of Wisconsin–Madison, has heard similar stories. “Patients with pain
have been unwitting victims of the war on drugs,” he says. Opioids have been a
hot potato since the 1961 United Nations Single Convention on Narcotic Drugs.
The US-led war on drugs that followed resulted in widespread reluctance to
prescribe and supply opioids for fear that patients would become addicted or
overdose, or that drug cartels would divert opioids to the black market. Cleary
says that countries such as the United States have an “unbalanced” opioid
situation, and that abuse in these countries has distorted policies elsewhere,
restricting legitimate access.
Continue reading->
[http://www.nature.com/nature/journal/v535/n7611_supp/full/535S16a.html?WT.ec_id=NATURE-20160715&spMailingID=51828243&spUserID=MjA1NzcwMjE4MQS2&spJobID=961919509&spReportId=OTYxOTE5NTA5S0]
–
A TENDER HAND IN THE PRESENCE OF DEATH
[HTTP://WWW.NEWYORKER.COM/MAGAZINE/2016/07/11/THE-WORK-OF-A-HOSPICE-NURSE]
Heather Meyerend is a hospice nurse who works in several neighborhoods
in South Brooklyn—Sheepshead Bay, Mill Basin, Marine Park, Bensonhurst, Bay
Ridge. She usually has between sixteen and twenty patients, and visits each at
home once a week, sometimes more. Some patients die within days of her meeting
them, but others she gets to know well, over many months. She sees her work as
preparing a patient for the voyage he is about to take, and accompanying him
partway down the road. She, like most hospice workers, feels that it is a
privilege to spend time with the dying, to be allowed into a person’s life and
a family’s life when they are at their rawest and most vulnerable, and when
they most need help. Some hospice workers believe that working with the dying
is the closest you can get on earth to the presence of God.
Heather is not brisk or efficient, as nurses in hospitals are. She is
purposely inefficient, in fact. Most of the time when she visits patients, she
doesn’t have much to do: she takes vital signs, she checks that there are
enough supplies and medications in the house, she asks if old symptoms have
gone away or new ones developed. If she were rushing, she could do all that in
about five minutes, but her visits usually last an hour or more. Sometimes
there is a complicated medical situation to take care of. Sometimes she does
something non-medical that needs to be done, which is the hospice way—she might
sweep a floor, she might heat up dinner.
Continue reading->
[http://www.newyorker.com/magazine/2016/07/11/the-work-of-a-hospice-nurse] ;
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TEACHING DOCTORS WHEN TO STOP TREATMENT
[HTTPS://WWW.WASHINGTONPOST.COM/NATIONAL/HEALTH-SCIENCE/TEACHING-DOCTORS-WHEN-TO-STOP-TREATMENT/2014/05/19/E643D190-CAF5-11E3-93EB-6C0037DDE2AD_STORY.HTML]
The woman came into the office with her husband, looking totally out of
place amid the frail geriatric patients at my palliative care clinic. Elegant,
slender, with a gorgeous head of curly blond hair, she was nothing like what I
expected when she had called a couple of weeks earlier, asking for a
consultation.
Her cancer story, too, was atypical.
The woman, a 50-something practicing clinical psychologist, had been
diagnosed with stage 4 non-small-cell lung cancer six years earlier, after
experiencing a persistent cough. By the time her tumor was removed surgically,
the disease had already spread outside the lung, so the patient received
chemotherapy and radiation treatments. With each recurrence or progression of
disease, the patient’s oncologist thought of a new approach, and each one
worked. The patient was able to maintain her busy practice and travel. She
hoped she might turn this cancer into a chronic disease instead of a death
sentence.
Given how well she appeared to be doing, I wondered why she was in my
office. We typically see patients with pain, fatigue or shortness of breath.
The woman had none of these symptoms.
Continue reading->
[https://www.washingtonpost.com/national/health-science/teaching-doctors-when-to-stop-treatment/2014/05/19/e643d190-caf5-11e3-93eb-6c0037dde2ad_story.html]
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INTERNATIONAL VISITORS [HTTP://PALLIUMINDIA.ORG/PROGRAMS/VISITORS/]
We welcome international visitors at Pallium India and appreciate the
support from our colleagues around the world. We request that you contact us at
least 2 weeks prior to your visit so that we can make the necessary
arrangements. Sorry; we would discourage “drop-ins” for fear of the impact on
patient care.
We have observership programs for interested professionals and
students, collaborative visits, and long term placements. Click here
[http://palliumindia.org/programs/visitors/] for more information. Contact: ;
visitors@xxxxxxxxxxxxxxxx [mailto:visitors@xxxxxxxxxxxxxxxx] ;
–
JOIN OUR FACEBOOK PAGE [HTTPS://WWW.FACEBOOK.COM/PALLIUMINDIA]
Pallium India’s Facebook page has over 5000 Likes. We regularly post
articles related to palliative care from around the world. Click here to Like
our page [https://www.facebook.com/palliumindia] ! We’re also on Twitter: ;
@palliumindia [https://twitter.com/palliumindia] ;
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PALLIATIVE CARE INFORMATION CENTRE [HTTP://PALLIUMINDIA.ORG/INFO-CENTRE]
Contact Pallium India’s Information Centre (9 am to 12 noon) for
information related to palliative care and about establishments where such
facilities are available in India. Telephone: +91-9746745497 or E-mail:
info@xxxxxxxxxxxxxxxx
Address: Pallium India, Arumana Hospital, Perunthanni, Trivandrum
For more details, please visit: http://palliumindia.org/info-centre/ ;
[http://palliumindia.org/info-centre/] ;
–
PARTING SHOT
WHAT ARE WE WAITING FOR?
[HTTP://PALLIUMINDIA.ORG/2016/07/WHAT-ARE-WE-WAITING-FOR/]
“You don’t need a law to provide palliative care”, says Lawyer Girish
Gokhale.
Hey, medical system, sit up and listen.
Mr Gokhale, your question shames us. We are prepared to discuss
endlessly about artificial ventilation of dying people. We have been discussing
that for 20-odd years of course; but that does not deter us; we go on and on.
But we are reluctant to make palliative care part of health care
delivery. Maybe it is too inexpensive to be attractive to us!
Read the report in Times of India dated 11 July, 2016: Doctor group
seeks law to spare patients needless med spend
[http://timesofindia.indiatimes.com/india/Doctor-group-seeks-law-to-spare-patients-needless-med-spend/articleshow/53145801.cms?from=mdr]
