Letting Go: Difficult Decisions in Advanced Diseases

Letting go is difficult for most people, be it in personal life or professional. As doctors we are trained to work towards saving lives. Clinical medicine presents us daily with scenarios where we know we will not be able to save a particular life, and it is here that we need to learn when and how to let go. Very often, expensive and intense life prolonging treatment only serves to prolong the misery of a patient at the end of life—and it very often serves to drain the savings of an entire family…….

On the occasion of World Cancer Day 2020, the Department of Medical Oncology at Goa Medical College organized a Continuing Medical Education activity to highlight and discuss issues about end-of-life care in various situations.

Dr R K Mani, acclaimed Pulmonologist and Intensivist from Batra Hospital, New Delhi who is an authority on end-of-life care in India spoke about his experience of 2 decades in forgoing life support in India. He stressed the need for empathetic and honest discussion with family members in these scenarios and enlightened the audience with the ethical and legal aspects of end-of-life care.

Dr Roop Gursahani, Neurologist from Hinduja Hospital Mumbai, spoke about decision making for the unconscious patient. He discussed the technicalities of brain death and the need for prognostication. He cited thought-provoking examples of unconscious patients where end-of-life discussions with the family led to, or failed to lead to good decision making.

The panel discussion that followed was moderated by Dr Anupama Borker, Head of Department of Medical Oncology. The panel consisted of Dr Edwin Gomes, Head of Department of Medicine, Dr Durga Lawande, Head of Department of Pulmonology, Dr Shaila Kamat, Head of Department of Anaesthesia, Dr Theresa Ferreira, Head of Department of Neurology and Dr Jose D’Sa, Director of Directorate of Health Services Goa.

There was lively discussion about various case scenarios and the importance of end-of-life discussions.

The event was attended by 215 participants.

Report written by: Anupama Borker Consultant and Head, Department of Medical Oncology, Goa Medical College
(This report has been edited by Djin Tay- APHN Volunteer Editor)