In an unprecendented move, the Supreme Court of India has admitted a public interest litigation by the Indian Association of Palliative care (IAPC) demanding improved access to palliative care for those who need it in the country. Currently, more than two million people with cancer and other incurable diseases are in needless pain and suffering, as the medical system rejects them once they are incurable. Kerala is the only state in the country that has a network of palliative care services, providing pain relief, symptom control and psychosocial support. Ms Poonam Bagai, a cancer survivor from Delhi and Dr Ravi Ghooi, a pharmacologist from Pune are co-petitioners. Dr M R Rajagopal, the chairman of its opioid availability committee represents IAPC. Ms Poonam Bagai had gone through the cancer journey herself. Dr Ravi Ghooi has seen his own mother suffering pain from cancer while the medical profession turned its back on her.

Palliative care is aimed at quality of life, rather than cure, and can go hand in hand with curative treatment. It has evolved into a well-developed medical and nursing specialty in the west. But though it came to India in 1986, it is still in its infancy in India. The Government, since 1980s, has paid lip service to it, and though palliative care was accepted as an integral part of cancer care, even today, majority
of even the Regional cancer centers do not have any palliative care facility.

The petitioners argue for the right to life with dignity for the hapless people with cancer and other incurable diseases. Morphine is an essential drug for pain relief; but unfortunately, unnecessarily complex narcotic
drugs and psychotropic substances (NDPS) act of 1985 prevents availability of the drug for people in pain. Modern science has clearly shown that oral morphine can be used with no reasonable chance of addiction, but still the medical community and the legal system refuse to change their attitude, leaving people in pain.

One of the petitioners, Dr Ravi Ghooi, moved the High Court of India in 1997, when his mother was in pain. But despite a favourable High court order, the situation continues with no substantial improvement. In 1998, the department of Revenue of Government of India asked all state Governments to amend and simplify the narcotic regulations, but majority of states and UTs have failed to comply, even after 9 years.

The petitioners argue for the right to life and death with dignity of patients with incurable illnesses, many of whom are awaiting their death with intense but avoidable pain, because of:

1. Non-implementation/inadequate implementation of the directives of the Government of India by the State Governments to modify the rules governing availability of morphine and other opioids required for pain control.

2.Absence of mechanisms and infrastructure for providing pain relief through palliative care centers and services, as palliative care continues to be a weak priority for many of the respondents in spite of the National Cancer Control Plan and States Governments' Cancer Control Policies.

3.Lack of education of doctors, nurses and medical and nursing students in palliative care.

The petitioners have requested the Supreme Court to instruct the central and state governments to develop palliative care policies. They also ask for adoption of realistic narcotic regulations and for standard operating procedures for their implementation. They also pray for inclusion of palliative care in undergraduate medical and nursing curricula by Medical and Nursing councils of India.