In September last year, an 83-year-old man presented to the emergency room at a tertiary-care teaching hospital in Kerala with severe chest pain and breathlessness. He was admitted to the intensive care unit, where I was on duty as an intensivist. The patient had been diagnosed with terminal lung cancer a few months earlier, and sent home to live the time he still had left. Since then, as his condition deteriorated, his family had already brought him to the hospital thrice. Each time, he was admitted to the ICU, where he was treated to relieve his symptoms before being discharged.
Once again, we started the patient on a battery of relief treatments. He was injected with opioids to relieve his pain and given steroids, he inhaled bronchodilators and oxygen to relieve his breathlessness. His relatives were asked whether, if and when the need arose, they wanted him to receive advanced life support—ventilator care and other invasive treatments—and whether they could afford them. They said they did, and could.
In the world of palliative care—a branch of medicine focussed on improving the quality of life of people with life-limiting illnesses, by relieving physical symptoms such as pain and offering psychological and spiritual care to both patients and their caregivers—practitioners distinguish between a “good death” and a “bad death.” A good death is one where the patient dies peacefully, without pain, in the presence of her loved ones and often at home. A bad death is one where the patient dies alone, often in unbearable pain, typically after having her life prolonged by aggressive and dehumanising care, usually in an ICU.
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