File: 90-year-old M Fernandes was locked out of his Vakola house in Mumbai by his son and forced to live in his building compound. With the intervention of police, only after a month of sleeping in an autorickshaw, surviving on food that neighbours provided and living in the fear of being physically abused by his own children, Fernandes could finally get back in the comfort of his own home. (Bombay TOI photo by Prasad Kumar)

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Palliative care is in need of a lifeline

An ashram for aged in Mangalore.

LONDON: India isn’t the best place in the world to die.The 2015 Quality of Death Index has placed India shamefully low – 67th among 80 countries in the world when it comes to people receiving good end of life care .This means that the people of countries as small as Ghana, Tanzania and Zimbabwe are reaching a more peaceful and dignified end to life compared to Indians.The Index says India and China perform poorly overall, at positions 67 and 71 respectively.“In the light of the size of their populations, this is worrying,” it adds.Research across 80 countries have found that end-of-life care in the UK is the best in the world, thanks to the extensive integration of palliative care into its National Health Service and a strong hospice movement. Australia was placed second best for good palliative care, followed by New Zealand, Ireland, Belgium, Taiwan and Germany. They were followed by the US, Netherlands and France.India’s neighbour Bangladesh is right at the bottom of the list – placed 79th with only Iraq worse than it.The Index says, “As governments across the world work to improve life for their citizens, they must also consider how to help them die well. In many countries, older people make up an ever-growing proportion of the population. Meanwhile, the prevalence of non-communicable diseases, such as heart disease, diabetes, dementia and cancer, is increasing rapidly. Taken together, this means that the need for palliative care is set to rise sharply.”“We’ve seen unprecedented changes in the way the world population is moving, with more people over the age of 65 than under the age of five,” says Stephen Connor from the Worldwide Hospice Palliative Care Alliance (WHPCA).Just 34 countries have above-average scores in the 2015 Quality of Death Index. Together these account for just 15% of the total adult population of the countries in the Index (which themselves account for 85% of the global adult population), meaning the vast majority of adults lack access to good palliative care.In only 33 of the 80 countries in the index are opioid painkillers freely available and accessible. In many countries access to opioids is still hampered by red tape and legal restrictions, says the Index.On India, Sushma Bhatnagar, head of anaesthesiology, pain and palliative care at the All India Institute of Medical Sciences says, “While the budget allocation for India’s 2012 National Program for Palliative Care was withdrawn, elements of the strategy remains in place and, as a result, some teaching programmes are emerging across the country. Moreover, recent legislative changes have made it easier for doctors to prescribe morphine in India.”She adds “India, for example, has a shortage of specialized care professionals and accreditation for palliative care is not yet the norm. However, the country is working towards changing this”.She says that in India, the passing in 2014 of the Narcotic Drugs and Psychotropic Substances (Amendment) Act by parliament brings legal clarity for physicians wanting to prescribe opioids to their patients. “Until recently, it was very complicated to procure and dispense morphine,” says Dr Bhatnagar. “Now, it will be much easier.”