Receiving the diagnosis for an illness that needs complex treatments over time is akin to being adrift in uncharted waters with no tools to navigate or weather the storms. Along with the physical burden of disease comes an avalanche of information and decisions: treatment plans, hospital visits, rising medical bills, and consultations with multiple specialists. Pain and exhaustion—whether from procedures and medications or from the emotional weight of witnessing a loved one suffer—are often constant companions in this journey.
Modern medicine is highly equipped at diagnosing disease and developing treatments to fight it. Yet, in the rush to cure, far less attention is paid to an equally important question: How is the patient living through illness?
Are they in pain? Are they able to eat, sleep, and breathe comfortably? Are they overwhelmed, frightened, or financially strained? How is the family coping?
Palliative care addresses these questions.
It is a specialised, interdisciplinary field of medicine focused on relieving suffering and improving quality of life for patients who are facing serious health conditions as well as their families. This includes not only physical symptoms such as pain, fatigue, nausea, and breathlessness, but also psychological stress, socio-economic pressures, and spiritual concerns.
Despite being a critical part of medical care, palliative care remains widely misunderstood, and by extension inaccessible for many. In India, an estimated 7–10 million people need palliative care each year, but less than 4 percent receive it.
Improving access requires better infrastructure, but also better understanding. Many of the barriers arise from persistent myths and a lack of information. We examine these myths through a lens of what is, in fact, true about palliative care.
1. Truth: Palliative care should begin early—alongside curative treatment—in serious illnesses
Palliative care is most effective when introduced early in the course of illness, often from the time of diagnosis. When integrated with treatments such as chemotherapy, surgery, or respiratory care, it helps patients manage symptoms, tolerate treatment better, and retain a sense of dignity and comfort.
Medical care is not supposed to follow a single straight line where ‘curative treatment’ happens first and palliative care only begins when all other active measures stop. The two forms of care should run in parallel, supporting patients and families throughout the course of illness.
Research across multiple fields—including oncology, neurology, and respiratory medicine—shows that patients receiving early palliative care often report better symptom control, improved quality of life, and even survival for a longer period of time.
Patients with heart disease, chronic respiratory illness, neurological disorders, kidney disease, dementia, and many other conditions benefit from palliative care.
Consider Meena,* a 52-year-old woman undergoing chemotherapy for breast cancer. The diagnosis itself is overwhelming. After her second chemotherapy cycle, she begins experiencing severe nausea, weakness, and anxiety. She wonders whether continuing treatment is worth the suffering. A palliative care team steps in early. They prescribe medications to control the nausea, teach energy-conservation techniques to reduce fatigue, and provide counselling to help her understand the treatment process. With her symptoms managed, Meena is able to continue therapy—and feels less alone in navigating her illness.
Historically, palliative care services were introduced very late in illness, often when curative treatments had been exhausted. This created the impression that palliative care is synonymous with end-of-life care or dying. However, Meena’s case shows that palliative care does not replace her oncologist. Instead, it strengthens the treatment team, ensuring that the patient’s comfort and well-being remain central to care.
There is also a misconception that palliative care is meant primarily for cancer patients. However, patients with heart disease, chronic respiratory illness, neurological disorders, kidney disease, dementia, and many other conditions benefit from palliative care.
The earlier it is introduced, the more it can help.
2. Truth: Good palliative care can help patients live longer
One of the most surprising findings in medical research is that patients who receive high-quality palliative care sometimes live longer than those who do not. This is not because palliative care cures the disease, but because it enables patients to stay the course through treatment, avoid complications, and build strength and resilience.
So, how does palliative care work?
- Symptoms are identified and treated early:Pain, infections, nutritional problems, and side effects from medications are addressed before they escalate.
- Patients are supported to continue treatment: When side effects become unbearable, many patients stop therapy prematurely. Palliative care helps manage painful or uncomfortable symptoms so treatment can continue. For instance, a patient with throat cancer begins chemotherapy but develops severe mouth ulcers and mucositis—an extremely painful inflammation of the oral lining. Unable to eat or speak comfortably, she decides to stop treatment altogether. When a palliative care team intervenes, they treat the ulcers aggressively through pain control measures, mouth care protocols, and nutritional support. Within days, the patient is able to resume treatment. Without symptom relief, the disease—not just the cancer but also the suffering caused by treatment—would have ended her therapy early.
- Anxiety and distress are reduced: Psychological stress can worsen physical symptoms and reduce adherence to treatment. For example, patients with interstitial lung disease (ILD) often experience episodes of breathlessness, which can be terrifying and cause anxiety. Their life shrinks gradually, until they are not just housebound but also on oxygen support and restricted to a bed. A palliative care physician would explain the disease trajectory to the caregiver and prepare them for acute exacerbations. They would also talk the family through decisions about the location of care: What would it take for the patient to be cared for at home? What preparations would be needed in case of emergency hospital admissions?
Additionally, palliative care specialists would equip caregivers and patients to manage breathlessness, including using non-pharmacological techniques such as pursed-lip breathing—similar to slowly blowing out a candle. This helps in regulating breathing and reducing anxiety during an attack. The patient, who may otherwise be afraid to engage with pulmonary rehabilitation exercises, learns how to use low-dose morphine before strenuous activity and tune in to the signals of their body. They would now walk slowly to the bathroom, maintaining independence and dignity. These small but evidence-based interventions can transform the daily lives of patients and their families.
This also challenges the myth that palliative care does not affect life expectancy. By improving symptom management, supporting treatment adherence, and reducing crisis hospitalisations, palliative care often supports both quality and length of life.
3. Truth: Palliative care helps patients make informed decisions about complex treatments
Serious illness often involves difficult choices such as deciding between treatment options, escalation of care, ICU admissions, life-sustaining treatments, resuscitation, ventilation, and artificial feeding.
Palliative care does not automatically recommend against these interventions. Instead, it helps patients and families understand what each option realistically offers. This includes discussing likely benefits and risks, potential impact on quality of life, and the values and treatment goals of the patient and family members.
These conversations are not about denying treatment—they are about ensuring that medical decisions align with what matters most to the patient.
For instance, an elderly patient with advanced heart disease is repeatedly admitted to the hospital for breathlessness. Doctors suggest a high-risk procedure that may extend life but involves prolonged ICU care. Through conversations facilitated by a palliative care team, the patient shares that his priority is to remain at home with his family rather than spend months in the hospital. Together with the cardiology team, a care plan is developed that focuses on symptom control, reducing hospital stay, and maximising home-based support. The patient may opt for shorter, time-limited trials of non-invasive ICU care with a planned early transition to home care. He still receives active treatment, but in a way that respects his goals.
This addresses the myth that palliative care discourages complex or life-saving treatment. In reality, it helps ensure that treatment decisions are informed, ethical, and aligned with the patient’s priorities.
4. Truth: Pain relief in palliative care is evidence-based and carefully regulated
Severe pain is one of the most distressing symptoms of serious illness. Decades of research have shown that opioid medications such as morphine, when used appropriately, are the gold standard of treatment for severe pain. In palliative medicine, opioids are prescribed within strict clinical frameworks that include careful patient assessment, precise dosing protocols, monitoring of side effects, and ongoing supervision by trained clinicians. When used in this controlled medical setting, the risk of addiction is extremely low.
Fear of opioid misuse has historically led to severe restrictions on access to pain medication in India.
For example, a man with advanced bone cancer experiences constant, unbearable pain. Without proper medication, he cannot sleep, eat, or sit comfortably. The pain causes acute mental distress and he expresses suicidal tendencies. Under supervised care, he begins a morphine regimen adjusted carefully to his needs. Within days, he can rest, talk to his family, and participate in daily life again. He sees the value in living. Pain relief restores not just comfort but also dignity.
Cases like these challenge the enduring myth around the prescription and use of morphine—that it inevitably leads to addiction.
Fear of opioid misuse has historically led to severe restrictions on access to pain medication in India. The Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985 created a complex licensing system that made it extremely difficult for hospitals and physicians to obtain, stock, and dispense morphine. This included highly punitive actions for even small clerical errors.
While a 2014 amendment simplified this system, gaps in implementation still limit access in many states.
Moreover, there is a lack of information that can be traced back to medical education. Elements of comprehensive pain relief, palliative care, and end-of-life care were only included in the undergraduate medical curriculum in 2019, with no trained faculty to teach them. This has essentially ensured that generations of doctors have not been adequately trained in safe opioid prescription.
All these factors have intersected to cause a pain epidemic. Ironically, while public debate often focuses on opioid misuse, millions of patients with severe illness continue to suffer unnecessary pain because these medications remain inaccessible. Responsible regulation is essential, but so is ensuring that patients in agony are not denied relief.
A growing need for palliative care in India
India is seeing a rapid rise in chronic and life-limiting illnesses. This growing burden makes palliative care an essential component of healthcare. Successful models already exist. States such as Kerala, Karnataka, and Telangana have demonstrated how integrating palliative services into primary healthcare systems and community networks can dramatically improve access.
Palliative care is not simply about compassion. It is grounded in clinical science, interdisciplinary teamwork, and ethical medical practice. And at its core lies a simple but powerful principle: to cure sometimes, to relieve often, to comfort always.
Dr Gopukrishnan Pillai contributed to this article.
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Know more
- Learn why home-based care for elders is essential in India.
- Learn about how health decisions in families are guided by socio-economic factors and cultural practices.
- Read about the current status of palliative care in India.
