With the rising burden of chronic diseases worldwide, palliative medicine has received increasing attention. Introduced in India in the 1980s, it is now offered as a specialised degree in several medical colleges. A recent report by the Rajya Sabha secretariat urged greater coverage of palliative care, especially for cancer, by including it in standard treatment protocols. Experts have been advocating this for decades. Yet, if medicine were truly complete, would palliative medicine exist as a separate branch?
What is palliative care?
Imagine you are a doctor. An 80-year-old woman falls at home and arrives at your hospital with pain and swelling in her left thigh and lower back. She had been independent all her life, but is now unable to walk. She lost her husband last year. He, too, had lost his mobility and spent six years bedridden before passing away from related complications. Her younger son had taken leave from work to care for his father and has now done the same for his mother. In addition, he is the primary caregiver for his elder brother, who suffers from severe depression. On top of this, he recently took a loan to send his son to college.
At the hospital, you find that this 80-year-old woman is seriously ill. Her kidneys are failing, and the fall has caused a spinal injury leading to compression of the spinal cord. This is why she cannot walk. She has also lost voluntary control over passing urine and stools, as the affected part of the spinal cord no longer functions. For the rest of her life, she will be bedbound, dependent on diapers and a urinary catheter. Her son will need to manually remove impacted stools, and the catheter will have to be changed every 2–3 weeks. Her failing kidneys also require dialysis. She will rely entirely on her family to feed her, change her clothes, turn her in bed, clean her, adjust her position, change her diaper, wash soiled clothes, and even attend to small comforts such as turning the fan on or off.
Palliative care is an approach, not a separate branch of medicine. It looks at the person as a whole, rather than at just lab values that need to be kept within normal limits. This approach focuses on quality of life, seeks to relieve suffering, and takes into account the wider impact of illness on the entire family, emotional, physical, and financial. It ensures that care is appropriate, avoiding both neglect and excessive treatment, as both can add to suffering.
Approach to treatment
What would you do if this lady came to you seeking care? The treatment could take two very different paths.
One option would be to pursue every possible investigation, establish the exact diagnosis, admit her to the Intensive Care Unit, start dialysis for her failing kidneys, transfuse blood to raise her haemoglobin, and follow the best available guidelines for scientifically proven treatment. This might extend her life. But it would come at a heavy price, not only financial but also psychological. Even after discharge, she would require dialysis twice a week for some time. She would still remain bedbound, living a life of complete dependence on others.
The other option would be to manage the acute condition, focusing on what immediately threatens her life and is adding to her suffering, while keeping in mind the limits of treatment, the financial strain, the likelihood that her kidneys may not recover fully, and the suffering that intensive interventions might cause. The focus would shift to reducing suffering. The aim would be to avoid overwhelming the family with expenses while ensuring the best possible quality of life. This would involve counselling the patient and her family, helping them understand that caring may be more meaningful than curing. That carrying her to the hospital twice a week for dialysis might cause her more suffering than benefit. That chasing strict blood test targets could add financial stress without truly improving her life. It would also involve training her relatives to provide the best care at home and, where possible, connecting them with local palliative care services to support the transition from hospital to home.
Palliative medicine specialists
Modern medicine has shifted its focus from caring to curing. A nephrologist focuses on the kidneys, a cardiologist on the heart, and every other specialist on their own organ system.
This fragmentation has also turned palliative care into a specialised branch. Relieving the physical, psychological, and spiritual suffering of the patient has now become the job of the “palliative medicine specialist.” And since death is often regarded as a failure in modern medicine, these specialists are usually brought in only when the patient is nearing the end of life.
But shouldn’t caring always be the responsibility of every doctor? Shouldn’t the physician’s duty be not only to add years to life but also life to those years? Is correcting lab values the only responsibility of a doctor, even if it imposes crushing financial burdens on the family? Does the role of a doctor stop at the hospital door, or should it extend to ensuring the patient has the knowledge and resources to be cared for at home? While palliative medicine specialists are experts in the domain, is it only their responsibility to address suffering?
Palliation, in all specialities
The principles of palliative care should be embraced by all doctors. Every medical student must be trained not only to provide clinically sound treatment, but also socially relevant care. The medical community must learn to accept death as part of life and recognise that the real failure is not death itself, but the absence of compassionate care.
Once every doctor understands that their primary duty is to provide care that is medically, socially, and financially appropriate, and to ensure their patients do not suffer, we will have countless palliative care practitioners. While specialists in palliative medicine are essential, given their expertise in managing complex symptoms and guiding difficult decisions, the wider gaps in access to palliative care need not be filled by specialists alone. These gaps can be significantly reduced if all doctors and healthcare providers integrate the principles of palliative care into their daily practice.
(Dr. Parth Sharma is a community medicine physician and a public health palliative care researcher. parth.sharma25@gmail.com)
Published – October 11, 2025 07:30 am IST
