An ancient Tamil wisdom speaks to a truth our contemporary medical system frequently overlooks:
“Vaazhvadharkaana kanniyathai polave, irappirkum kanniyam mukkiyamanadhu.”
(Just as dignity in living holds importance, dignity in dying carries equal weight.)
India proudly commemorates each medical advancement that prolongs life. Our achievements in curative cancer treatments and other non-communicable diseases (NCDs) have been extraordinary, continuously expanding the frontiers of human longevity. However, in this unwavering quest to add years to life, we have overlooked the equally crucial goal of adding life to years. We have mastered the art of battling death while remaining novices at guiding the transition toward it. This imbalance has spawned a quiet yet widespread crisis: the abandonment of palliative care.
This abandonment originates from a fundamental misconception. To many, “palliative” serves as a coded word for surrender—spoken in subdued voices, perceived as medical abandonment, a final pathway to end-of-life management. This stigma represents not only a tragedy but also a grave error. It denies millions of patients and families access to care that delivers comfort, preserves dignity, and extends compassion precisely when these are most essential.
Clarification is essential: Palliative care differs fundamentally from hospice care. Hospice addresses the terminal phase when curative options have been exhausted. Palliative care, conversely, should commence immediately upon diagnosis of any serious, life-threatening condition. It represents comprehensive support that operates alongside curative interventions.
Consider a patient receiving chemotherapy. While the oncologist concentrates on tumor reduction, the palliative care team centers on the patient’s total well-being. They address excruciating pain, manage nausea that prevents nutrition, treat anxiety that disrupts rest, and combat depression that dims hope.
Palliative care encompasses symptom management, complication prevention, and psychosocial support for patients and families from diagnosis onward. Its purpose is ensuring optimal quality of life, independent of prognosis.
The objective focuses on addressing humanity’s fundamental comfort requirements: Pain relief, restorative Sleep, and nourishing Food. When these elements are properly managed, patients can better endure primary treatments while maintaining their fighting spirit.
Without structured palliative care systems, families bear the entire caregiving burden. This generates a catastrophic, often unmeasured financial disaster.
While we discuss out-of-pocket expenditure (OOPE) for medications and hospitalization, we overlook the devastating costs families face managing complex symptoms independently.
Families may spend thousands on emergency transportation for midnight hospital visits to address sudden breathing difficulties. They purchase expensive, frequently ineffective over-the-counter pain medications. They attempt to manage complicated wound care, urinary catheters, or feeding tubes without proper training, resulting in infections and costly hospital readmissions. This creates an avalanche of preventable suffering and economic devastation.
A well-organized palliative care system, particularly one emphasizing home care, prevents these emergencies. A skilled nurse making home visits can control pain, provide wound care, educate family members in basic care techniques, and detect complications before they become crises. This approach not only reduces expenses but, more significantly, delivers invaluable peace of mind.
Additionally, we must acknowledge the tremendous strain on caregivers—spouses, children, and relatives who become unprepared, continuous care providers. They experience severe physical and emotional exhaustion. Palliative care recognizes this reality and extends support through counseling, temporary relief, and bereavement assistance. It understands that illness affects entire families, not isolated individuals.
This vision transcends theory—it exists today in Andhra Pradesh’s villages. The Sri Sathya Sai Palliative Care Centre in Puttaparthi provides an exemplary model. Within just a few years, it has delivered free, comprehensive care to over 1,100 patients spanning 143 villages.
The approach is beautifully straightforward yet remarkably effective. It integrates a 10-bed inpatient unit for acute symptom control with two mobile homecare units conducting 12 daily visits within a 50-kilometer radius. A physician, nursing team, pharmacist, and support staff handle everything from chronic pain, breathing difficulties, and nausea to complex procedures including catheterization, wound management, and colostomy care. Most patients (66%) have cancer, while a substantial portion (34%) suffer from chronic kidney disease, stroke, and other debilitating conditions.
The Puttaparthi model’s key insight lies in its flexible nature. It acknowledges that palliative needs fluctuate. Patients may require intensive inpatient care for symptom stabilization, followed by routine home visits. This fluid integration of home, daycare, and hospital services represents the future of care. Remarkably, this comprehensive compassion network operates on an annual budget under Rs50 lakhs—a fraction of establishing a single high-technology ICU bed.
The Puttaparthi model’s success proves that excellent palliative care isn’t exclusive to affluent urban areas. It remains achievable, cost-effective, and expandable. The challenge involves transforming these isolated centers of excellence into a comprehensive national strategy.
Premier institutions like the Indian Council of Medical Research (ICMR) must lead this transformation. Just as ICMR has directed India’s cancer care policies, it must now champion palliative care as a national health imperative. We require an ICMR-directed task force to examine successful models, conduct implementation studies, and create adaptable frameworks that states and union territories can modify for their specific geographical and socioeconomic circumstances.
A practical initial step is already progressing. Mission UTTHAN, a flagship initiative under the Office of the Principal Scientific Adviser to the Prime Minister, is launching a pilot program establishing comprehensive palliative care in the Andaman and Nicobar Islands.
This challenging location, with approximately 10,000 patients requiring care, will function as a practical testing ground.
By connecting a homecare network with government hospitals and utilizing telemedicine through the National Cancer Grid (NCG), this initiative aims to develop a robust template for nationwide implementation.
To create a sustainable system, we’re also addressing the critical workforce shortage. Through collaboration with the Health Sector Skill Council (HSSC), we’ve created a “Palliative Care Assistant” program training local residents, simultaneously generating employment while providing care.
Fundamentally, advocating for palliative care means reconnecting with our profound cultural and spiritual foundations. An ancient Sanskrit verse eloquently expresses this universal human longing:
“Ānāyasena maranam, vinā dainyena jīvanam”
(Grant me death without suffering, and life without misery.)
This verse doesn’t request eternal life, but dignity. It acknowledges that peaceful death represents the final, crucial element of meaningful life. As medical science progresses, we must ensure our compassion matches our technological capabilities.
We must construct healthcare systems that not only preserve lives but also honor them completely, throughout their entire duration.
Integrating palliative care into our national health mission represents the most meaningful approach to achieving this goal.
