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The Mathura Declaration – a call to action to promote palliative and end of life care in India

15 June 2017

Representatives from the Indian Association of Palliative Care (IAPC), Indian Society of Critical Care Medicine (ISCCM), and the Indian Association of Neurology met together at Mathura in Uttar Pradesh on 29 and 30 April this year.

The resulting document: ‘The Mathura Declaration‘ called for ensuring compassionate care at the end of life. The Declaration will be forwarded to the Government of India.

‘The Mathura Declaration’ aims to promote palliative and end of life care (EOLC) to those who are terminally ill and dying. 

The newly formed Citizens’ Action Needed for Dignity in Death (CANDID) and a multi-professional medical association called End of Life Care in India Task force (ELICIT), bring together, for the first time, individuals from varied walks of life to promote humane and compassionate care of terminally ill and dying persons. 

This advocacy was found to be necessary against the backdrop of inadequate awareness among the public, care-providers and policy-makers, of the complex issues around compassionate and appropriate care of terminally ill and dying persons that impact every citizen’s life. 

Palliative and end of life care (EOLC), is about appropriate transitioning from disease-oriented care to symptom management, ensuring comfort in the dying phase.

The Mathura Declaration states the following

  1. Quality of life is a right guaranteed under the Constitution to every citizen of India and must be upheld, including at the end of life.
  2. Palliative and end of life care (EOLC) are important means to ensure this. 
  3. In 2015, India was ranked 67 among 80 countries in the Quality of Death Index, based on a survey conducted by The Economist Intelligence Unit. We as a nation must examine the reasons why this is so and take swift remedial measures.
  4. We recognise the efforts of the medical and ethics community in India to clarify the ethical obligations of doctors and to define evidence based practice points for EOLC. In this context, we welcome the government’s historic initiatives last year seeking general opinion and feedback on a draft Bill termed: 'Medical treatment of terminally ill patients (protection of patients and medical practitioner’s Bill)'. 
  5. We see this as an opportune time for a constructive response by a broad range of stakeholders. We strongly urge all caregivers, professionals, citizens and policy makers to participate in building consensus for a comprehensive and contemporary national framework for improving palliative and end of life care in India.

Find out more about the Mathura Declaration on the websites of the Indian Association of Palliative Care and Pallium India.

References

  1. Quality of Death Index. The Economist Intelligence Unit, Lien Foundation; 2015. Available from: http://www.eiu.com/sponsor/lienfoundation/qualityofdeath
  2. Downar J et al. Crit Care Med 2014;42:824-30.
  3. Myatra, Salins et al, Indian J of Critical Care Medicine 2014:18:71-9
  4. Rajagopal. Opinion page. TOI. 20 June 2016.
  5. Gurshahani, Mani. Indian J Med Ethics; 2016; 13: 30-5.
  6. Mani, Ind J Crit Care Medicine 2014;18: 562-567.
  7. Mani, Simha, Gurshahani. Opinion page. TOI, 5 Feb 2016.
  8. Macaden SC. Indian J of Palliat Care 2017;23:1-2.

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