In 2014, 58-year old Michael*, battling end-stage cancer, was told that he had close to two months to live. He was shifted to Ave Maria Hospice, a Palliative care centre that looks after terminally ill patients at Vamanjoor in Mangaluru.
Fast forward to 2018, Michael, now 62, lives on and was shifted to a long-term care facility for the terminally ill. "It is an extraordinary case of increase in life-expectancy. We are glad to provide some kind of assistance to the patient who was brought with this incurable condition," says Dr Lavina M Noronha, Director, Ave Maria Palliative Care.
In 10 years of its existence, Ave Maria Hospice has provided end-of-life care for close to 590 patients suffering from symptoms that were considered to be incurable. Every year, the multi-disciplinary team at the hospital receives patients suffering from Parkinson’s, cancer, Alzheimer’s, chronic kidney diseases etc.
And in the face of the Supreme Court verdict allowing passive euthanasia, Dr Lavina says palliative care is an alternative that upholds the right to live with dignity – and is, at the same time, less stressful for families.
Dr Lavina says that palliative care provides emotional, spiritual, and social support, necessary both for the patients suffering from life-limiting conditions, and to their families.
"We are just adding life to the terminally ill patients. We try to reduce their pain by providing them medical assistance from time-to-time and upholding their right to live with dignity. We also reduce the emotional concerns of the families who realise that their loved ones are in the hands of professional caregivers," she says.
The Supreme Court recently upheld the right of people to die with dignity, and allowed for a ‘living will’ and for passive euthanasia – where patients can decide if they do not want to be on life support in case of terminal illnesses.
However, Dr Noronha believes that passive euthanasia is emotionally distressing to families, and that her organisation is 'pro-life' and does not support the practice.
"The family of the terminally-ill feel emotionally stressed as it is not easy for anyone to let go of their loved one. In passive euthanasia, the medical professionals generally withdraw nutrition, surgeries and life-support from terminally-ill patients, which otherwise would increase their longevity," she says. Palliative care, she believes, is a good alternative.
In the context of people raising the need for active euthanasia, Dr Lavina further says that the provision can be misused.
"A person who is depressed because of some issue in the personal or professional front may always prefer death over life. In the spur of the moment, they may opt for physician assisted suicide, with a lethal dose or some other method. So the question is, where do you draw the line?” she asks.
“In any case we are opposed to both passive and active euthanasia," she says.
On an average, the general life-expectancy of the patients at Ave Maria Hospice is a little over four months. The centre says they have helped over 550 terminally-ill patients have a comfortable death.
At present, the palliative care centre is staffed with four qualified nurses, eight health assistants, a social worker, visiting doctors and two supervising staff. It has 15 beds.
According to the Institute of Palliative Medicine, India has an estimated one million people diagnosed with cancer every year and more than 80% of the patients are incurable after the first diagnosis. "The country is estimated to have an equal number of patients with other incurable diseases like progressive neurological, cardiac, respiratory, AIDS and other diseases. With the rapid ageing of the Indian population, the highest number of patients needing palliative care in the future will be from among the elderly," a representative from the Institute of Palliative Medicine says.
As per the Worldwide Hospice Palliative Care Alliance, only Kerala, through its neighbourhood network, stands out in providing qualitative palliative care and accounts for two thirds of India’s palliative care. Whereas the Economist Intelligence Unit's (EIU) Quality of Death Index report in 2015 claimed that India stood at a measly 67 out of 80 countries.