Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
I concur fully with this author. My personal experience in India is
more than 15 years ago but I do not think anything has changed. Somebody I
knew was dying of advanced cancer. She was treated in a private
hospital 'actively' and on seeking my advice asked her husband to take her
home so that she can die at home. She was confused, probably from brain
metastasis and I requested one of the doctors I know to give her some
dexamethasone, that would also make her feel better and give her a better
appetite. She had multiple bone metastasis and was in pain. The doctor I
spoke to would not give her either the dexamethasone or morphine. The
argument was that the morphine would kill her! Many people with advanced
and incurable cancer die in pain, not because the drugs were not available
but many doctors cannot bring themselves to give the drug and accept the
concept of palliation. They are also afraid that the relatives may accuse
them of causing the patient's death.
The doctors need education to believe in palliative care, especially
to understand that death is inevitable. If they are convinced, they can
talk to the patient and relatives (once it is clear that there are no
curative options)and explain that the aim of management is palliative and
not curative anymore. I am sure the patient will understand and indeed
many will be grateful for allowing them to die comfortably, than in pain.