By Dr. Waseem Gill
When I first put pen to paper for this article, my thoughts went back to my own experience as a medical practitioner caring for my wife in her final days. Not as a doctor, but as a husband and a concerned family member.
Previously healthy, she was diagnosed with an aggressive stage 4 uterine cancer, with limited chances of successful treatment. Her prognosis was around two years, but as a family we were determined to give her every possible chance of a longer life. Options for her specific and rare form of the disease were limited. She underwent surgery followed by chemotherapy, but relapsed after several months and chemotherapy was tried again. When that failed, immunotherapy was offered as part of a clinical trial. Unfortunately, this too was unsuccessful and may, in fact, have exacerbated her condition, a recognised but rare side effect of immunotherapy in which, instead of activating the immune system to attack cancer cells, tumour growth accelerates.
At this stage, around 18 months into her illness, it became clear that the outcome was no longer acceptable. We were informed that no further active treatment would benefit her and that care would now focus on symptom relief, comfort and dignity in the weeks she had left. At this juncture, my wife shifted her mindset from one of survival to one of acceptance.
She initially spent a short period in a cancer hospital, then at home, but ultimately chose to spend her final days in a hospice, where she would be cared for by a healthcare team skilled in managing complex symptoms, including pain. She did not want our home to become a reminder, for those she would leave behind, of her final moments. She wanted it to remain a place associated with her energy, warmth and role as the heart of the family.
With effective symptom control, she lived her final days in a dignified, pain-free and controlled manner. She arranged financial support for our children and spent nights reciting verses of the Quran with her sister, who remained by her side throughout her final weeks. She planned her own funeral with the help of a childhood friend and left voice notes for our children on how to face life’s challenges, including her own death. She told them her passing should not hold them back, but instead motivate them to pursue positive achievements in the limited time we all have.
She accepted the time she had on this earth and felt ready for her soul to move on to the next phase of existence. Her final days and hours were spent surrounded by family and friends. She passed away peacefully, pain-free and with dignity. Today, we remember her through positive recollections of her achievements and the contributions she made to her family and work.
Before moving further, I want to share a harrowing quote relayed to me by a physician caring for a poor cancer patient who was unable to access pain-relieving controlled drugs. Due to their scarcity in Pakistan, the patient had to obtain them illicitly.
“Doctor, it has always been difficult to live in Pakistan. Now it is difficult to die in Pakistan.”
Palliative care is not limited to end-of-life care or pain relief, although these are important components. It is much broader and represents a specialised field of care that has only recently gained recognition in Pakistan.
It can be provided at any stage of illness and alongside curative or life-prolonging treatments such as surgery or chemotherapy. Palliative care may benefit patients with cancer, heart failure, chronic respiratory disease, chronic kidney disease, neurological conditions such as stroke and multiple sclerosis, advanced frailty in old age, serious infections and other complex medical conditions associated with a high symptom burden.
Pakistan has very few trained healthcare professionals in palliative care and even fewer with qualifications recognised by the Pakistan Medical and Dental Council. This is woefully inadequate for a country of nearly 250 million people, where serious illnesses and advanced cancers are common and curative treatment is often not possible. This gap is particularly stark given that around 75 percent of cancers in Pakistan are diagnosed at stage 3 or 4.
Pakistan records close to 200,000 new cancer cases each year, with more than 100,000 cancer-related deaths annually. Many of these patients would benefit significantly from palliative care and effective pain relief. Globally, around one in four people will be diagnosed with cancer at some point in their lives, meaning most families will encounter a need for palliative care at some stage.
Palliative care treats the whole person, addressing physical, emotional, social and spiritual needs, while also supporting families. Through open and honest discussions, it helps patients and loved ones understand what to expect and supports informed decision-making.
It focuses on relief from symptoms such as pain, breathlessness, fatigue, nausea, anxiety, depression and other sources of distress. Care is delivered by a multidisciplinary team that may include physicians, nurses, social workers, spiritual care providers and other specialists working together.
Looking ahead, Pakistan must take coordinated and affirmative action to integrate palliative care into its healthcare system. This includes recognising palliative care as an essential health service, revising restrictive regulations that limit access to controlled medicines, and incorporating structured palliative care training into undergraduate medical and nursing education. Strengthening primary care services will also allow palliative care to reach patients in the setting of their choice.
By acknowledging the growing need for palliative care, Pakistan can move towards a more compassionate, honest and equitable healthcare system, one that prioritises relief from suffering and upholds dignity at every stage of life.
(This article is written by Dr Waseem Gill, MBBS (London), MRCGP, MBA, DRCOG, DFFP, Cert.International Health Consultancy, a UK Healthcare Consultant who trained in Family Medicine)