Death competence is the order of the day, says Rajagopal

Dr MR Rajagopal delivers the eighth edition of the Dr TK Ramachandran Memorial Lecture on “Let's Change the Ending – Insights into Death, Dying and Medical Instructions” in Kochi on Monday. | Photo credit: RK Nithin

Dr MR Rajagopal, an anaesthetist and chairman emeritus, Pallium India, who pioneered palliative care in Kerala in 1993 by founding the Pain and Palliative Care Society, said end-of-life competence is the need of the hour as various factors still prevent a comfortable death for most people.

He was delivering the eighth edition of the Dr TK Ramachandran Memorial Lecture here on Monday on the topic 'Let us change the ending – insights into death, dying and medical instructions'. “Withdrawal of artificial life support is not euthanasia. While in Europe, unfortunately, around 90% of artificial life support is withdrawn when proper recovery proves impossible and end of life is certain, in India this figure is only 30%. As Dr Sankha Mitra said, here the poor die in the misery of neglect, the middle class in the misery of ignorance, the rich in the misery of ventilators and no one experiences a painless and dignified death,” he said.

At the end of life, well-being is the most important factor, so one should take care of managing pain and other physical symptoms while avoiding unnecessary disease-related procedures, unnecessary use of antibiotics and hospitalization, especially in intensive care. Surgery, radiation or chemotherapy should also be avoided unless they are needed to relieve pain. Even feeding tubes are not necessary unless they are already in place or the person is hungry but cannot swallow, he said. Instead, psycho-socio-spiritual support is needed, including listening to one's stories without judgment, acknowledging feelings such as grief, regret and guilt, and acknowledging successes. “Sometimes just being there and being silent is enough,” he said.

He also referred to the Supreme Court's 2023 ruling on the living will, describing it as protecting the common citizen from intense torture. “If I sign a document expressing my will and can name a trusted person to make decisions on my behalf, doctors should have an ethical and legal duty to respect my will,” he added.