Published on: February 1, 2023

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Dear Friends,

Supreme court reviews 2018 judgement on end-of-life care

On a matter of supreme importance that concerns you, me and every single citizen of India, in response to a petition from the NGO ‘Common Cause’, the Supreme Court of India had validated the importance of advance medical directives (AMD) and of withholding / withdrawing (WH/WD) artificial life support in the context of futility of treatment. The judgement was a moral victory emphasising the importance of human dignity at the end-of-life; but the procedures laid out by the court were so complex that we are not aware of a single person who went through WH/WD following that process in the last five years. 

In response to a review petition, the Supreme Court has now simplified some of the processes:

1. AMDs no longer need to be countersigned by a magistrate. Attestation by a notary public or a gazetted officer would be enough. And the magistrate is no longer required to keep a copy; it is to go into a central repository.
2. For WH/WD, it is no longer needed to involve the district collector; nevertheless it is still necessary to form two committees of specialist doctors one after the other. The first one has to take a decision in two days; it is not clear how long the second committee will take. 
3. The court continues to refer to WH/WD as ‘passive euthanasia‘. For one thing, the word euthanasia involves ‘killing’ however noble be the objective. WH/WD is allowing natural death. The use of the phrase ‘passive euthanasia’ is likely to cause an enormous burden of guilt on families and professionals. It would also invite religious objections. 

The final detailed judgement is yet to be published, though. We shall update you as soon as we know more.

But it is important to remember that the legal position is not necessarily the most critical factor affecting end-of-life care. We believe that the doctor’s knowledge of duty of care, the family’s awareness and the social perception are even more important, as we have tried to depict in the following image.

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Bringing Severe Pain to an End

“The need for palliative care is greater in LMICs because disease-specific treatment does not reach patients adequately or in time.  Consequently, palliative care casts a wider net in these countries, going beyond symptom control, end of life care or specific disease groups.”

Smriti Rana, Pallium India’s Head-Strategic Programs and Partnerships, writes: Bringing Severe Pain to an End

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‘Walk with the Weary’ (2nd edition) getting released at IAPCON in Bengaluru

The new edition of ‘Walk with the Weary – Life Changing Lessons in Healthcare’ by Dr M R Rajagopal, published by Aleph Book Company, with a Foreword by Dr Shashi Tharoor MP, will be released at IAPCON 2023, Bengaluru.

Dr Nagesh Simha (Medical Director, Karunashraya Hospice) will hand over a copy of Walk with the Weary to Dr Sushma Bhatnagar (President of IAPC and the Director of the WHO Collaborating Centre at AIIMS, New Delhi).

This will be followed by a book-signing by the author.

Time: 5 pm

Date: Friday, 10 February 2023 (immediately following the plenary)

In Walk with the Weary: Life-changing Lessons in Healthcare, Dr Rajagopal knits his own experiences as a doctor with stories of the unique lives of his many patients, asserting that medicine can bring comfort and security to those at their most vulnerable and provide them the opportunity to not only live healthy lives but to die with dignity. Read more.

Get your copy here:

Aleph Book Company: https://www.alephbookcompany.com/book/walk-with-the-weary-life-changing-lessons-in-healthcare/

Amazon IN: https://www.amazon.in/Walk-Weary-Dr-M-Rajagopal/dp/9393852448

Flipkart: https://www.flipkart.com/walk-with-the-weary/p/itm681283c8fd982

A doctor writes on the importance of palliative care and treating patients with empathy

“If some pass on with anger in their hearts, there aresome others who spread love and joy around them in the brief time they are with us. This is story of a brave young girl whose sweet but painful memory will always be with us.” Read an excerpt from ‘Walk With The Weary: Life-changing Lessons in Healthcare,’ by Dr M R Rajagopal.

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Cycle Rally

A cycle rally to commemorate Kerala Palliative Care Day (January 15, 2023) was organized by Pallium India in partnership with Sthiti, Life Care Foundation & Alappuzha Initiative in Palliative Care. The riders started from Palakkad on January 11 and reached Trivandrum on Jan 14, 2023.

Anshad Hassan, Viswaraj. B, Dileep. R, volunteers from Sthiti, carried the message of palliative care, the need to hold hands and take care of each other for a compassionate community. As palliative care and environment activists, they are keen to develop palliative care services in Palakkad. This was a journey of learning and discovery for these young men, who will become future leaders and torchbearers of the palliative care movement.

Anshad, Viswaraj and Dileep were welcomed warmly by Pallium India’s staff and beneficiaries on January 14, 2023. Dr Kala Keshavan (Principal, Govt Medical College) was the chief guest at the event. Justice M R Hariharan Nair, Dr Gopukrishnan Surendran and Dr Sunil Kumar spoke at the occasion. Anshad shared their experiences during the ride.

Our thanks to palliative care enthusiasts and organizations who provided support to the riders along the way.

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Dr Rajagopal receives Best Doctor Award

Chairman of Pallium India, Dr M R Rajagopal was one of the recipients of the Best Doctor award instituted by the Nehru Group of Institutions and the P K Das Institute of Medical Sciences (PKDIMS), Vaniyamkulam, in memory of Nehru group founder P.K. Das. The awards were presented at a function hosted by the PKDIMS on January 14, 2023.

6 doctors from Kerala and 3 doctors from Tamil Nadu were selected for the awards considering their services in four categories. The other recipients of the award are:

P. Rajan, (Former Professor of Surgery at Government Medical College, Kozhikode), P.S. Shajahan, (Professor of Pulmonology at Government Medical College, Alappuzha), Annie George, (Professor of anatomy at Government Medical College, Kottayam), C. Raveendran, (Additional professor of surgery at Government Medical College, Thrissur), V. Narayanan, who works among the tribespeople of Attappady, N.S. Kumaresan and S. Thangavel from K.G.M. Hospital, Coimbatore, and Pari Selvaraj, (Managing Director of Manu Hospital, Coimbatore).

Read the announcement in The Hindu: https://www.thehindu.com/news/national/kerala/nehru-group-to-honour-best-doctors-in-kerala/article66369102.ece

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Poonam Bagai receives ‘PeakLife Women Who Inspire’ Award

Ms. Poonam Bagai (Founder Chairman, Cankids…KidsCan and Vice Chairman, Pallium India) was bestowed the ‘PeakLife Women Who Inspire’ Award, presented by Audi India and powered by Austria Tourism, to celebrate trailblazing women in the arenas of business, sports, science, finance and aviation.

The award recognises her leadership in the fight against childhood cancer in India and across the world. Congratulations, Poonam!

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Thank you, V-Guard Foundation

Thank you, V-Guard Foundation, for the donation of a Tata Winger (12 seater), as part of their CSR initiative, for Pallium India’s home care, and for training healthcare professionals and volunteers at TIPS.

Keeping in mind the health requirements of the underprivileged sections of our society, V-Guard CSR has endeavoured to create awareness of diseases, provide access to primary healthcare with the assurance of timely diagnosis and make the availability of life-saving medication easy for them. Through their healthcare CSR Initiatives, V-Guard has supported primary health centres, facilitated health awareness programmes, and provided ambulances and medical equipment across India.

The key handover function was attended by Mr. Saneesh K, (Sr.officer CSR) and Mr. Lovejith (Marketing Manager). Ashla Rani, Trustee of Pallium India, received the vehicle on behalf of Pallium India.

Our heartfelt gratitude to the V-Guard team for supporting us towards a larger vision, to reach millions of those going through serious health-related suffering in India. We look forward to continued collaboration.

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Pallium India – through the eyes of a Nurse from Portugal

“Even though many things in India and Portugal are different, we share more similarities than I thought related to health care. Pallium India has been walking on a path of palliative care education throughout India. I believe, in Portugal all the palliative care teams have been trying to do the same, educate more and more about palliative care. Making sure palliative care and death literacy are available to a greater extent (either patients, families and other healthcare professionals). Although there’s still a long way to walk, being here makes me more optimistic than ever.”

Rita Mascarenhas Pessoa, a nurse from Portugal, visited Pallium India for a few weeks in January 2023. She shares her experiences.

Read the complete article >> https://palliumindia.org/2023/01/rita-portugal-pallium-india

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The Platinum Rule: A New Standard for Person-Centered Care

By Harvey Max Chochinov

How decisions are made and patients cared for are often guided by the Golden Rule, which would have us treat patients as we would want to be treated in similar circumstances.

But when patients’ lived experiences and outlooks deviate substantively from our own, we stop being a reliable barometer of their needs, values, and goals. Inaccurate perceptions of their suffering and our personal biases may lead to distorted compassion, marked by an attitude of pity and therapeutic nihilism.

In those instances, The Platinum Rule, which would have us consider doing unto patients as they would want done unto themselves, may be a more appropriate standard for achieving optimal person-centered care. This means knowing who patients are as persons, hence guiding treatment decisions and shaping a tone of care based on compassion and respect. Read more >>

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CAREERS / OPENINGS

For more openings, visit our CAREERS page:
https://palliumindia.org/category/career

In case of queries, please write to us: career@palliumindia.org

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Video of the Month

What happens as we die?

Most of us have never seen anyone die. Few have any idea what to expect as death approaches, and most have unrealistic fears about it. Dr Kathryn Mannix wants to change that.

Please listen to this deeply insightful talk by Dr Kathryn Mannix at TEDxNewcastle

Click here to watch: https://www.youtube.com/watch?v=CZDDByT0Vr0

Subscribe to Pallium India’s youtube channel for videos related to palliative care and our activities. You can watch previous webinars and training sessions, as well as listen to caregivers, survivors and others sharing their experiences.

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Events / Courses

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Check out upcoming events: https://palliumindia.org/events
Queries? Contact: info@palliumindia.org

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Opioid Workshop with Meghalaya Drugs Department

In January 2023, Meghalaya State Drug Department took the initiative to conduct an Opioid Workshop, facilitated by Pallium India.

Read this note written by Ron Sangma (Regional Coordinator-North East India, State Facilitation team, Pallium India): https://palliumindia.org/2023/01/opioid-workshop-meghalaya

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Opioid Workshop in Ladakh

Pallium India organized an online opioid availability workshop for the Union Territory of Ladakh, facilitated by Dr M R Rajagopal (Chairman of Pallium India), on January 3, 2023. Mohd Bashir Bandey, (Drug Controller, Ladakh) attended the event, along with 24 other participants including Dr Sunil Kumar Ahirwar (In-charge officer, NPPC NHM), and Dr Tashi Thinlasand (Palliative care consultant, NCD Leh), Dr Rinchan Dolma DH Kargil and others from Leh and Kargil district hospitals of Ladakh. 

Rajendra Dutt Bijalwan, representing Pallium India, welcomed everyone and introduced the agenda of the meeting. 

Dr Rajagopal explained the NDPS Amendment Act of 2014 and the subsequent 2015 Rules in the state/UTs. He clarified that the licensing process through Excise department is no longer valid and that the State/UTs Drug Controller is the authority who can issue Recognized Medical Institution (RMI) license to applicants for stocking Essential Narcotic Drugs (6 drugs of which Morphine, methadone and Fentanyl are available in India). He also answered the questions raised by the participants.
 
(Report prepared by Rajendra Dutt Bijalwan, Regional Coordinator-North India, State Facilitation, Pallium India)

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Exploring alternative and complimentary medicine in palliative care.

Mr Mujeeb Kuttamassery, Secretary, Kerala State Chapter, National Association of Palliative Care for Ayush & integrative medicine (NAPCAIM) reports:

Suraksha Palliative Care Centre at Kochi, Kerala, takes up the challenging task of exploring relevance of Ayurveda in Palliative Care. Ms Gilly Burn inaugurated the initiative on 26th January and Dr Piyush Gupta, National Secretary, NAPCAIM, was the chief guest.

Vaidyratnam Dr Raghavan Ramankutty and Mr K. Radhakrishna Menon, National Vice President of NAPCAIM were among the distinguished speakers.

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SAHAYATRA

Sahayatra, Pallium India’s monthly print magazine in Malayalam, is meant for anyone interested in Palliative Care – patients, families, palliative care professionals, volunteers and well-wishers.

Yearly subscription rate for Sahayatra is ₹200. (Only ₹500 if you subscribe for three years.) However, we send Sahayatra free of cost to patients and their families.

To subscribe to Sahayatra monthly magazine, please send your complete postal address to info@palliumindia.org. Contact: 97467 45504

Read previous issues of Sahayatra online: https://palliumindia.org/sahayatra

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PARTING SHOT

This Little-Known AirPods Feature Allowed My 95-Year-Old Grandfather To Hear Me Again

by Pranav Dixit

Whenever I visited Aba, my maternal grandfather, who lives in India, he burst with questions. He wanted to know how I was, and whether I still liked my job. He wanted to know what I had for dinner each day, and whether I still worked out. He wanted to know how the internet works, and what exactly was a Facebook.

Each time I answered, however, his face would settle into a puzzled expression. He’d lean in closer and look faintly annoyed. I spoke again, and again, and then one more time, my voice growing louder and louder until I was practically shouting at him. Then his shoulders drooped, and he waved me away with a resigned sigh.

At 95, Aba can’t hear much. 

Continue reading: This Little-Known AirPods Feature Allowed My 95-Year-Old Grandfather To Hear Me Again

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