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The Hindu
5 days ago
- Health
- The Hindu
A good death, demystified
Benjamin Franklin, in 1879, observed that certainty is limited to two things - death and taxes. Time and technology have proven him only half wrong. Sigmund Freud on the other hand, had remarked that we are all convinced of our immortality. Discussing death is considered, varyingly, macabre, ghoulish, grim or in morbid taste. Serious discussions on definitions of death, of personal, moral, legal and economic issues involved in death-related-decisions, seldom occur in Indian families. Do clinicians constantly exposed to death, become insensitive, forgetting that for the bereaved family, it could be the first experience? From time immemorial, a doctor's primary avocation was 'to cure sometimes, to relieve often, to comfort always'. Until recently, there was no conflict of interest with this approach, when a doctor did his best to preserve life. However, the increasing availability of sophisticated medical technology and life support systems has changed the picture. The process of dying is now more protracted, and can be influenced to be prolonged. The importance paid to 'quality of life' should now also be paid to 'quality of death.' Understanding death Death (apoptosis) commences even in the unborn, where cells are programmed to die. Different organs die at different rates. Death is an ongoing process, not an isolated event. Saving lives is the raison d'etre for our existence as doctors, but at what cost? In the irreversibly critically ill patient, how long does one continue treatment? What is the purpose of such treatment? Today, one can keep a person biologically alive - heart, lungs, kidney and other organs functioning - but in coma, 'living' in a critical care unit setting. In 2018, the Supreme Court held that the right to die with dignity, is a fundamental right. When the patient is unable to take part in the decision-making process of medical treatment, who will be the surrogate decision maker? Even if full information is given, is it reasonable to expect a calm, unruffled calculated decision to be taken, with death hovering around? Do we factor in the patient's desire? When is enough, enough? Should management decisions be based only on irrefutable scientific evidence and available technology? Do increased 'options' compound the issue? Do we spend quality time with caregivers understanding psychological, social and spiritual needs when death is imminent? Illustrations from neurosurgical practice A 92-year-old woman with a stroke that has affected both sides is encouraged to be taken home. She also has multiple hip fractures secondary to a trivial fall. Two months have elapsed. The patient is in coma for four weeks. Morphine patches are used for analgesia. The 70-year-old son cannot stand her suffering. After a discussion, the Ryles tube feeding is stopped, to facilitate an irreversible cardiac arrest. The heart goes on beating for another 72 hours, with the elderly children going through an agonising time. How does one discuss a 'good death' with a just -married wife, when her husband has had a devastating bleed in the brain? How does one inform a retired professor of surgery that he has multiple secondaries not only in the brain but everywhere, and therapy will only postpone the inevitable? Examining 'good death' In 'good death', treatment preferences, quality of life/death and maintenance of dignity is as per the patient's desires. There is no distress or suffering for the patient, family and caregivers, and attempts are made to ensure little or no pain (through the use of morphine for instance). Death is consistent with prevailing clinical, cultural and ethical standards. Excessive, futile treatments are not used to prolong life. There is trust, support and comfort with the team and an opportunity to discuss all beliefs and fears and to bid farewell to one's near and dear. When end of life is inevitable and patients/families consent, aggressive therapies, medications and interventions are stopped but care is never withdrawn. A good death is not a single final event, but a series of social events. The team commiserates with the family, empathises, sympathises with the individual who has placed his/her life in our hands. Support is necessary throughout the dying process. Earlier understanding facilitates a good death. Dying at home is an important component of good deaths. Terminal illnesses offer time for discussion and resolution of unfinished psychological and practical business. A good death includes not being a burden to the family, leaving affairs in order and having a sense of fulfilment. A bad death is being kept alive against one's wishes, a loss of dignity, an inability to communicate one's wishes, the excessive use of medical technology and dying alone. India was ranked 67 out of 80 countries, on the 2015 Quality of Death Index, published by the Economist Intelligence Unit, signalling the urgent need to legislate on, and implement good death policies in our country. (Dr. K. Ganapathy is a distinguished professor at the Tamil Nadu Dr. MGR Medical University and past president of the Neurological Society of India and the Telemedicine Society of India. Email: drkganapathy@
Daily Record
09-05-2025
- Daily Record
75,000 tourists descend on tiny town with population of 8,000 creating 'gridlock'
The town of Sirmione in Italy was overtaken with visitors waiting 40 minutes to get through the gates A small Italian town was swarmed by tourists on the May Day Bank holiday as a reported 75,000 visitors arrived to sightsee. Sirmione, on the shores of Italy's Lake Garda which has a population of just 8,000, was overrun with traffic halted and gridlock. Sightseers eager to spend the day in the scenic spot were forced to wait 40 minutes to get into the town through it's gates in the centre and locals were left furious by the scenes. The narrow streets were thronged with holidaymakers who were there to visit the town's Roman ruins, thermal baths and it's 13th century Scaligero Castle. Residents of the medieval town were left furious by the invasion which halted vehicles and even the town's electric buses, reports The Sun. They took to social media to vent their anger as videos on platforms showed crowds piling into the area. On X, formerly Twitter, one said: "Overrun by tourists — chaos, gridlock, and hours of waiting. A crisis that must be urgently addressed and regulated. It damages our heritage and turns the experience into a negative one." The Mirror said another disgruntled user raged: "Overtourism is what happens when presence is confused with existence. "Fast, loud, empty. Like fast fashion — disposable and harmful. Travel less, mean more." A local group called Siamo Sirmione ('We Are Sirmione') also spoke out against overtourism in their home city - which has been famously linked to historical figures such as Sigmund Freud to James Joyce. They said: "If this is the council's management model the risk is not just hardship for residents but a real and lasting harm for the tourism and image of Sirmione." Roberto Salaorni, the official responsible for transport, admitted the crowds could have been managed better. He said: "This is the first thing to do, possibly installing a barrier at the entrance to the castle, which would enable us to manage exceptional situations such as we saw on Friday." But he added he'd never "seen so many people" visiting Sirmione or the neighbouring towns. Italy is among a number of European destinations that have been fighting against high levels of tourism. In Venice, local officials were forced to limit large tourist groups - but the rule has long been ignored. Marco Merlo, president of the hotel and restaurant operators association, told the Times that he was "very worried about public safety and the quality of life for tourists, residents and workers." He said: "We hope the council will involve us in finding effective and widely agreed strategies."
Daily Mirror
07-05-2025
- Daily Mirror
Town overrun by 75,000 tourists sparking 'gridlock' as sightseers wait 'hours'
Sightseers were reportedly left waiting 40 minutes just to make it through the town centre gates as vast crowds 'overran' the area - with around 75,000 visitors reported to have landed on the resort Tens of thousands of tourists swarmed a small Italian town over the May Day bank holiday - creating a "gridlock" that halted traffic and left other sightseers waiting "hours" to get in. The 75,000 travellers sparked fury after descending on the narrow streets of Sirmione, a village of just 8,000 residents on the scenic shores of Lake Garda in Italy. The site, known for its Roman ruins, is home to a number of thermal baths and the majestic 13th-century Scaligero Castle. Sightseers were reportedly left waiting 40 minutes just to make it through the town centre gates over the weekend as vast crowds "overran" the area. A whopping 75,000 visitors are reported to have landed on the resort to visit the fortress, according to The Sun. Shocking footage circulated online showing throngs of travellers piling into the area. The endless sea of people stopped caused gridlock traffic for residents in cars and electric buses, with locals left outraged by the deluge. "Overrun by tourists — chaos, gridlock, and hours of waiting," said one on X recalling the chaotic spectacle. "A crisis that must be urgently addressed and regulated. It damages our heritage and turns the experience into a negative one." Another disgruntled user said: "Overtourism is what happens when presence is confused with existence. Fast, loud, empty. Like fast fashion — disposable and harmful. Travel less, mean more." Marco Merlo, president of the hotel and restaurant operators association, told the Times that he was "very worried about public safety and the quality of life for tourists, residents and workers." He said: "We hope the council will involve us in finding effective and widely agreed strategies." A local group called Siamo Sirmione ('We Are Sirmione') also spoke out against overtourism in their home city - which has been famously linked to historical figures such as Sigmund Freud to James Joyce. "If this is the council's management model the risk is not just hardship for residents but a real and lasting harm for the tourism and image of Sirmione," the group wrote. Roberto Salaorni, the official responsible for transport admitted the crowds could have been managed better. He said: "This is the first thing to do, possibly installing a barrier at the entrance to the castle, which would enable us to manage exceptional situations such as we saw on Friday." But he added he'd never "seen so many people" visiting Sirmione or the neighbouring towns. Italy is among a number of European destinations that have been fighting against high levels of tourism. In Venice, local officials were forced to limit large tourist groups - but the rule has long been ignored.
Time of India
06-05-2025
- General
- Time of India
Six arrested, minor detained for rape of two teenagers
More than dreams: 10 Sigmund Freud quotes that dive deep into human nature On May 6 we celebrate the birth anniversary of one of the most revolutionary minds- Sigmunf Freud. The man, who gave birth to psychoanalysis, was not just a pioneering neurologist. He was a cultural force who reshaped the way we understand the human psyche, identity, and behavior. Freud's ideas was bashed as uncomfortable and disconcerting, however they hold a respectable place in modern dared to explore the unconscious mind at a time when it was barely recognized. He invited patients to speak freely from the couch in his Viennese office, encouraging them to share their thoughts, memories, and dreams without censorship. Through this method, he uncovered the hidden as well as complex layers of desire, repression, and conflict that, he believed, shaped much of human behavior. It was Freud who first insisted that truly listening—deeply and without judgment—was key to healing the his work has sparked decades of debate and reinterpretation, Freud's influence remains profound. He painted an unflinching picture of the mind as a battlefield between instinct and reason, between what we know and what we try to life, too, was shaped by upheaval. In 1938, as the Nazis took over Austria, he was forced to flee Vienna. He spent his final year in London, where his home at 20 Maresfield Gardens—now the Freud Museum—preserves his library, collections, and the original psychoanalytic couch that launched a honor his birthday, let us look at 10 quotes that offer a window into Freud's extraordinary mind— Times Of India
Time of India
06-05-2025
- General
- Time of India
2 Thane cops arrested for selling CDRs to pvt detective agencies
More than dreams: 10 Sigmund Freud quotes that dive deep into human nature On May 6 we celebrate the birth anniversary of one of the most revolutionary minds- Sigmunf Freud. The man, who gave birth to psychoanalysis, was not just a pioneering neurologist. He was a cultural force who reshaped the way we understand the human psyche, identity, and behavior. Freud's ideas was bashed as uncomfortable and disconcerting, however they hold a respectable place in modern dared to explore the unconscious mind at a time when it was barely recognized. He invited patients to speak freely from the couch in his Viennese office, encouraging them to share their thoughts, memories, and dreams without censorship. Through this method, he uncovered the hidden as well as complex layers of desire, repression, and conflict that, he believed, shaped much of human behavior. It was Freud who first insisted that truly listening—deeply and without judgment—was key to healing the his work has sparked decades of debate and reinterpretation, Freud's influence remains profound. He painted an unflinching picture of the mind as a battlefield between instinct and reason, between what we know and what we try to life, too, was shaped by upheaval. In 1938, as the Nazis took over Austria, he was forced to flee Vienna. He spent his final year in London, where his home at 20 Maresfield Gardens—now the Freud Museum—preserves his library, collections, and the original psychoanalytic couch that launched a honor his birthday, let us look at 10 quotes that offer a window into Freud's extraordinary mind— Times Of India
