Ethical dilemmas in palliative care in traditional developing societies, with special reference to the Indian setting
- Dr S K Chaturvedi, National Institute of Mental Health & Neurosciences, Bangalore 560029, India;
- Received 7 August 2006
- Revised 1 April 2007
- Accepted 4 April 2007
Background: There are intriguing and challenging ethical dilemmas in the practice of palliative care in a traditional developing society.
Objective: To review the different ethical issues involved in cancer and palliative care in developing countries, with special reference to India.
Methods: Published literature on pain relief and palliative care in the developing countries was reviewed to identify ethical issues and dilemmas related to these, and ways in which ethical principles could be observed in delivery of palliative care in such countries are discussed.
Results: The literature review revealed a number of ethical dilemmas and challenges that professionals, cancer patients and their families encountered during palliative care. It was noted that patients’ preferences and decisions are influenced by family members. Dilemmas leave the professionals and families confused about how ethical their actions have been. Specific ethical issues were noted in relation to the availability and use of oral morphine for pain relief, spiritual care, lack of adequate palliative care services, and palliative care education.
Conclusions: The four principles of ethics posed difficulties in understanding the complex ethical issues in a developing country with a traditional background. Ethical issues need to be handled delicately and sensitively in palliative care settings, within the framework of the traditions and culture of the society and financial constraints. The possible role of ethics committees in palliative care settings to help decision-making needs to be studied and discussed.
Competing interests: None. The author is one of the founding members and a former vice-president of the Indian Association of Palliative Care. He has also been a member of the NIMHANS Ethics Committee.