off record
Shaukat Ali Jawaid

Making the death
more expensive


Patients used to die in the past and they die even today but what has changed is that now death has been made much more expensive. Thanks to the developments in technology, greedy physicians who are infected with materialistic virus and business like attitude of healthcare facilities. A good surgeon should know when not to operate, similarly a good healthcare professional should know when curative treatment needs to be stopped but it most often does not happen. It does involve some ethical issues but one of the basic principles of bioethics is that one should do no harm to the patient if one cannot do any good. It is essential that patients should have dignified death.

Many terminally ill patients are kept on curative treatment particularly in cities even when the treating physicians are sure that they are not going to live longer. They need palliative care rather than curative services. One of the speakers making a presentation during the conference at a Five Star private healthcare facility was delighted to state that they were able to make the correct diagnosis of a congenital disease utilizing the advanced technology diagnostic facilities in Singapore. When asked what about treatment, what is the prognosis and how much did it cost to arrive at the diagnosis, it was stated that it did cost about seven lac rupees to the family but the disease is incurable. Was it an ethical approach, certainly not? In many cases the patients are kept in the Intensive Care Units un-necessary for longer periods just dictated by the financial gains by the healthcare facilities. In some cases even terminally ill cancer patients are kept on respirators though it may not be required. Many cancer patients are either diagnosed or come to the hospitals when the disease has fairly advanced and are in Stage-III or IV when very little could be done to save their lives. These patients and families need counseling and provision of palliative care in which nurses play an important role. However, palliative care facilities are not available in Pakistan and this discipline of medicine is almost non-existent. On the contrary professorial chairs of palliative care exist in the developed civilized world.
The importance of palliative care in general and in terminally ill cancer patients in particular were highlighted at a seminar on palliative care held at University of Health Sciences Lahore last month. We need to promote this discipline and medical universities can play an important role in this regard. They can start Diploma Courses in palliative care, start certificate courses in palliative care for nurses thus making available palliative care services in Pakistan. Our health planners, medical administrators and senior healthcare professionals must realize the importance of palliative care and take appropriate measures.{jcomments on}

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