Terminal Diseases: Underlying Behavioural and Social-economic Issues
Socio-economic Aspects of Terminal Diseases: With respect to the economic, demographic, and healthcare development, India is passing through the transitional phase. During the last two decades, India has shown remarkable economic development, but the acquired progress has benefited a very small section of already rich people. Consequently, there is a drastic increase in the economic disparities among society. On the basis of demographical factors. The socio-economic inequalities of Indian population reflect in all walks of their life including health care and management. So socio-economically, Indian health sector can be divided into parts; the first part includes the health services for the elite class, whereas second part is serving the poor section of society. Provisions of healthcare for rich class and urban population are wonderful and provide the best health care facilities. It has also emerged as medical tourism for many foreign nationals. Whereas the healthcare sector, serving the poor class has a severe shortage of basic healthcare facilities, like; trained and qualified manpower, medicines, infrastructure and other resources.
As a result of economic corrective measures and social security provisions, implemented by the Indian government to minimize economic inequalities, have improved the status of health in India. India has made remarkable growth over the past few decades. Life expectancy in India has crossed 65 years, the infant mortality rate has decreased. But still, the net outcome in respect of poor man’s health is petty small. Even after implementation of the corrective measures; India is still facing the triple challenge to its healthcare system at all the local, state and national level. Major threats to the healthcare system in India are: there is no effective control on the infectious diseases, poor management of non-communicable diseases associated with lifestyle and lack of effective strategy for newly emerging pathogens causing epidemics and pandemics. Besides this, the available Indian healthcare infrastructure is poor in quality and inadequate in quantity. To provide optimum healthcare for all, India needs to enhance and strengthen its per-capita healthcare facilities by developing global level infrastructure and human resource. Majority of the diseases share common psychological and behavioral risk factors such as living in the prolonged stressful condition, anxiety, depression, use of tobacco, alcohol, unhealthy diet, unhygienic living conditions, lack of awareness about health hazards and lack of physical exercise.
Terminal illness is a comprehensive term which may include a set of medical diagnoses, as it happens in the diseases, like; AIDS, amyotrophic lateral sclerosis (ALS) etc. There are other illnesses like cancer, which may not necessarily be a terminal illness in their initial stage but if not treated appropriately in time, may result in terminal diseases.
Behavioural and Psychological Issues:
A complete screening of the health status of individual will help the medical team to decide, whether the diagnosed disease is a non-acute, acute, chronic or terminal disease. If a terminal disease is identified, in that case, sharing such news with the patient is a tough challenge, because that person may experience many overwhelming, conflicting bombardment of emotions. Knowing about such news may deteriorate or shatter the normal psychological, emotional and behavioral state of the individual. So, the news should be given in the presence of family members, a trained counselor or support group. When the person is diagnosed with the terminal disease, the patient and his/ her family members exhibit overwhelming emotions and undergoes a disturbed psychological state the counselor or support group should help them to ventilate out their conflicting emotions and finally cop with the situation.
Terminal diseases result in unwanted and painful changes in the life and to the body of the patient, which ultimately deteriorates not only the physical and medical state but also the psychological and emotional condition of the person. Psychologically person may face depression, anxiety, stress, mood disorders and emotional tantrums, followed by the feelings of acceptance for the present medical and psychological state. People living in such a state may face the various problems and challenges, such as: how much time they are left with, what should be the course of treatment, what other type of care are necessary for longevity of residual life, from where and whom the care should be taken, how to manage finance for treatment and care of illness and also for the livelihood of family, what about family after death, how to pass the residual time, how to handle their own conflicting emotions and emotions of the family members during progression of the disease, how to complete the residual assignment related to his/ her personal life and other family members and lastly how to say goodbye to the family members, friends and known.
In the cases when a child is diagnosed with any terminal illness, s/he or family members might not know the details of what has happened, so either the doctor or counselor can help to understand the diagnosis. Informing children about death a difficult as they are not aware of the concept of death.
Terminal Disease and Options
1. Palliative care: A specialized team of doctors, paramedical staff and psychologists can provide palliative care to people with terminal illnesses at their home, hospital or hospice. Palliative care involves medication and management for controlling pain, body changes and psycho-emotional problems. This care helps to provide the best possible life and comfort in the deteriorated state of end-of-life.
2. Death with dignity: Under this option, a terminally ill person of sound mind with certain medical conditions is prescribed a medication, on his consent, by the qualified and authorized medical practitioner to end his/her life at a place and time of his choice. Death with dignity is simply understood as medically assisted suicide and this option can only opt in the countries where it is legal.
3. Psychological Intervention and need of a counselor:
Elizabeth Kubler- Ross has defined certain psychological and emotional states experienced by the persons suffering from terminal illness and approaching to end-of-life.
- Denial stage: in this stage people diagnosed with terminal illness feel very difficult to accept that it has really happened to them.
- Stage of Anger and Resentment: in this stage, people express their anger and resentment for the reason, why it has happened to them.
- Bargaining Stage: in this stage individual try to do everything to prolong the duration of residual life.
- Stage of Depression: In this stage feeling of hopelessness, sadness, grief and loss dominate the mental state of the individual.
- Stage of Acceptance for Death: In this stage, the individual has accepted for the illness and ready for death.
At the end-of-life of the person diagnosed with terminal illness, counseling and therapeutic intervention can be of great help. The basic purpose of psycho-therapeutic intervention is to support the individual for effective emotional processing, relationship management with family members, caregivers, friends and others. Also, for providing effective support to prepare the person to face the death with ease. Counselors can also address the need of companionship for such terminally ill people, those who are either discarded by the family or have no one to care for them.
Terminal illness results in pounding of many negative emotions altogether and needs coping strategies for them. The counselor can help them to identify and develop coping strategies. For coping with the psychological and emotional problems psychotherapy, lifestyle modifications and medications can be practised. Psychotherapy is given by the expert to the person with a terminal illness for the better understanding of changing physical, psychological and emotional condition, and also to face comfortably and easily the end of their life. Lifestyle modification involves leaving or learning certain habits, such as leaving the habit of smoking or drinking alcohol or learning meditation or exercises to reduce the impact of depression, anxiety and other psychological disorders resulting from the terminal illness. Medication can help individuals to reduce the pain, changes in body and psycho-emotional problems.