Palliative Care is an essential service of the branch of medicine. Its availability and impact play a major role in ascertaining Right to Health. The importance of opioid analgesics like morphine has been highly regarded. It is often adopted for first-in-line treatment for moderate to severe pain, especially in terminal diseases.
Right to Life is a Fundamental Right under the provision of Article 21 of the Indian Constitution. It also entails within itself the Right to Live with Dignity. A person suffering from chronic pain deserves access to basic medications and analgesics. Restriction of the same through impositions of the law is an infringement of the person’s fundamental right.
The interesting fact to note is that these are effective as well as cheap. Yet, its access to the public who are in dire need of the same is close to nil.
This highlights India’s Opioid Paradox — the existence of an unfair rift between India being one of the world’s largest opioid producers and the number of patients that die due to chronic pain in the country. It also sheds light on the issue of inequality.
It all narrows down to the stern drug policies within the nation.
Role of NDPS Act
India’s Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985 enacted regulations to control the distribution and availability of drugs and misused substances. The law authorizes state governments to regulate the manufacturing and possession of medicinal opium.
The immediate result of adopting the Act was a drastic reduction in morphine consumption in India, of about 97%.
A research conducted by WHO in collaboration with the Centre for Policy and Communications in Cancer Care enumerated 2 main reasons for this, deriving from the NDPS Act:
- A minimum of a mandatory 10-year prison term
- Cumbersome licensing procedures.
As a result of exhausting procedures and severe penalties, hospitals and practitioners avoided acquiring and maintaining their licenses.
Drug Policy Catalyzing Inequality
An alternative in the form of Fentanyl patches (costing up to 10 times more, and not being as effective as basic analgesics) has occupied the market. The private sector has a concentration of these patches due to their high costs. As a result, the inaccessibility of the available option to the people who cannot afford private healthcare is evident. It is driving inequality in the society, between the rich and the poor.
The law has made it difficult for the public to get equal access to basic healthcare. The rich are being able to afford the available alternative whereas the poor are not. This establishes the issue of lack of equity that exists.
The United States of America’s infamous opioid epidemic and India’s need for opioid analgesics have similar roots. The main cause being incapability of people to perform their basic daily tasks, struggling and dying due to chronic pain. Medical professionals and advocates share the genuine need for opioid medication time and again.
It is correct that the advent of opioid medications and their easy access is a dark reality of America. But to prevent that from happening in India is where the role of creative legislation lies.
Impact of Lack of Palliative Care in times of COVID-19
Over 400,000 people have died from COVID-19. There is no cure yet and the symptoms in serious cases are painful. The older generation is affected the most, especially with difficulty in breathing and chest pains. It is vital to integrate palliative care into COVID-19 health responses. This will help ease and reduce serious symptoms of breathlessness and chest pain.
The World Health Assembly also shares concerns that the serious health conditions and distressing deaths seem to be avoidable by the few people who are receiving palliative care, hinting at the beneficial impact at a large scale of the same.
According to UK and Swiss Researchers:
“Emergency-style palliative care needs to be adopted in acute settings in order to meet the needs of Covid-19 patients who would not benefit from a ventilator”.
It is clear that the death of a few critical patients is inevitable. It is imperative to understand that a person can be too ill to recover or enjoy established procedures to treat the illness. But they still need their symptoms managed or pain reduced which provide them with a fair chance of their right to live their remaining life with dignity. This thus protects their fundamental right of right to life.
The need for a well-established palliative care system is achievable through three main steps:
(i) bringing a change in drug policy (reduction in a prison term, establishing easier licensing procedures);
(ii) training in the medical community, and
(iii) raising awareness about the medical use of opioids and removing the stigma surrounding it.
Even though it seems too ideal, State of Kerala has shown that it is both possible and can be successful. It is a model case study to understand the implementation of the ideal suggestions.
India has 908 palliative care sites, amongst which Kerala alone houses 841 of them – making it one of the largest of such networks in the world! More than 170 institutions now stock and dispense oral morphine, in Kerala. It serves as an inspiration to other State Governments and the Nation as a whole. It drives the Government to bring about the required changes and take a step further in the protection of basic fundamental rights.
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