Minimising the pain of dying
You don't have to live, and die, in pain.
Palliative care addresses the physical and mental wellbeing of patients and families facing problems associated with life-limiting illnesses.
PAIN is the most dreaded of sensations experienced by all of us. Pain affects us in all manner of ways. Pain makes us scream, or simply stay still in the hope that it goes away.
Pain is the piercing spear that stabs us deep when we lose someone dear to us.
Pain represents loss – loss of control, loss of function, and even loss of hope.
Pain brings thoughts of death and dying to the extent that some may even be compelled to an argument that death is kinder than a life of enduring pain.
Despite the incredible advancements in healthcare, we are still somewhat blinded to dealing with patients with pain.
It is surprising that despite the sheer prevalence of pain affecting most patients, it is not a subject that receives much instruction in medical education.
Surgeons, physicians and oncologists are experts in dealing with many of the diseases that define their speciality, but pain management is an elusive skill often acquired as an aside.
A country’s use of medicinal morphine and other similar drugs is often taken as an indirect measurement of the level of pain and palliative care services in that country.
Malaysia languishes in a ranking of 72, with a consumption of 0.7392 mg/capita, while the world mean is 6.24 mg/capita (2014)
Why is this so?
We have all the medications we need to reduce pain, and we are producing increasing numbers of doctors and nurses.
Yet, many patients in pain are not getting the pain relief they require.
For many patients with cancer and other debilitating diseases, they have to cope with treatments and side effects, and try and live a life with pain.
Families and loved ones feel helpless watching the suffering of the one they love so much.
In 2014, the United Nations (UN) Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez, said: “States also have an obligation to prevent pain and suffering that amounts to cruel, inhuman or degrading treatment.”
Méndez urged governments around the world to ensure full access to palliative care of all terminally ill patients, including older persons, and overcome all obstacles that restrict availability to essential palliative care medications.
“States should promote widespread understanding about the therapeutic usefulness of controlled substances and their rational use,” he specified.
Healthcare systems that ignore the need to have accessible and good quality palliative care will never be able to effectively promote and protect the right to health and related human rights of their citizens,” the UN Special Rapporteur on the right to health, Dr Dainius Puras, said.
The central tenet of pain through torture is that by removing the act of torture, much of the pain will be relieved. Yet, with cancer and chronic pain, the pain will NOT go away without medication and other treatment.
Some in society feel that assisted suicide is an answer rather than improving pain management and prescribing palliative care. Are we so quick to give up on our loved ones?
The central purpose of palliative care is to improve the quality of life of patients and families by reducing pain and suffering.
Working with oncologists, physicians and other doctors who are experts in disease management, we are able to make a huge difference in reducing pain and suffering.
Yet, despite having 25 years of palliative care in Malaysia, huge numbers of patients have unresolved pain.
A useful analogy is that of driving a car. The principal purpose of a car is to take us from point A to point B.
But it is the comfortable seats, air-conditioning, good suspension, brakes and music that make the journey comfortable. Why can’t we do the same in healthcare? The medication, chemotherapy and radiotherapy help to deal with the disease.
It is the pain relief, and social, psychological, emotional and spiritual support, that makes fighting the disease not just bearable, but meaningful.
Good and effective palliative care does that. Is that too much to ask for when someone is in pain?
Suffering from pain really doesn’t need to happen.
Palliative care
Palliative care addresses the physical and mental well-being of patients and families facing problems associated with life-limiting illnesses.
These illnesses include cancer, HIV/AIDS, organ failure or degenerative neurological disorders.
Hospis Malaysia offers palliative care to patients within the Klang Valley. It is also a leading provider of training and education on palliative care and a strong advocate for greater accessibility to this area of medical speciality in the country.
The organisation is committed to advancing palliative care programmes and research with the aim of ensuring that palliative care, which is already part of the World Health Organisation (WHO) definition of universal health care, becomes fully integrated into the country’s healthcare system.
The vision is to provide the highest quality of palliative care so as to provide relief from pain, and prevent pain and suffering associated with progressive and life-limiting illnesses.
Palliative Care Awareness Month 2017
Initiated by Hospis Malaysia, the National Palliative Care Awareness Month aims to place the importance of improving access to palliative care services on the national agenda so that unnecessary pain and suffering from a life-limiting illness can be significantly reduced and properly managed.
The theme for the campaign occurring throughout this month is Living and Dying in Pain – It Doesn’t Have to Happen.
Around the world, 75% of people cannot access the controlled medicines they need to treat moderate to severe pain. This may result in people living and dying in treatable, but uncontrolled pain.
Dr Ednin Hamzah is Hospis Malaysia’s chief executive officer. For further information, visit: www.hospismalaysia.org/palliative- careawareness-month-2017/
We don’t even ask happiness, just a little less pain. Charles Bukowski (1920-1994), poet and novelist
If we listen and observe carefully, the dying can teach us important things that we need to learn in preparing for the end of our own life’s journey. Robert L. Wise, Crossing the Threshold of Eternity: What the Dying Can Teach the Living