ABSTRACT: Homoeopathy has a great role in palliative care. The law of similia which is applicable for curable cases is also applicable for the palliation of incurable states. Homoeopathic remedies act as a palliative and give a soothing effect in cases where complete cure is not possible. So, homoeopathy can ensure a compassionate end-of life- care so that patients can spend their final days meaningfully, amongst their loved ones.
KEYWORDS: palliative care, homoeopathy, palliation, end of life care, homoeopathic remedies for palliative care, law of similia in palliation
Abbreviations: HIV – human immunodeficiency virus, AIDS – acquired immune deficiency syndrome
Homoeopathy is alternative system of medicinal therapeutics discovered in 1796 by the great physician Dr Christian Friedrich Samuel Hahnemann. It is based upon the principle of “similia similibus curentur”- ‘let likes be cured by likes’, which signifies that a remedy selected for the treatment of a natural disease shall be the one that is capable of producing a range of similar symptoms in a healthy person.1
The homoeopathic medicines help to fight against diseases by assisting the body’s natural ability to provide relief for symptoms of the illness, rather than suppressing the symptoms.2 This therapy adopts an individualistic and holistic approach towards the sick individual. A homoeopathic doctor does not treat in the name of disease, rather the treatment is targeted against the “patient” who is suffering from a particular disease.3
Development of pathology
Disease per se is the morbid process of functioning of the life-principle; if this process is unchecked, it eventually leads to structural changes. These structural changes might be of two types viz., reversible and irreversible: they are the end-results of morbid vital process and act as obstacles to restoration of the abnormal vital process to its previously healthy condition. The more the pathological changes are of severe degree and of irreversible type, the less the chances are for recovery. Hence, the pathological state of the patient is certainly one of the factors impeding recovery and its knowledge is therefore essential for a physician-therapeutist.4
The various aspects of a physician’s mission are:
- To cure in curable cases.
- To palliate in incurable cases.
- To preserve health.
In cases, where pathology is so advanced so as to become irreversible, homoeopathic medicines can provide a great soothing effect. Homoeopathy has a positive role in improving the quality of life in incurable chronic diseases like cancer, HIV/AIDS, terminally ill patients and incapacitating diseases like rheumatoid arthritis, etc.
Role of homoeopathy in palliative care
Homoeopathy adopts a symptomatic treatment of the ailments of the patients. Using homoeopathic remedies for palliative care specifically pain relief is safe and free from side effects, even on long term use. Single remedy in potentised form is employed on the basis of the law of similia for the palliation of incurable states also.
The homoeopathic simillimum, the remedy chosen based on the totality of symptoms, is always the best treatment and can have deep acting effects —sometimes creating a prolongation of life and well-being even when the prognosis is bleak.5 When time is short and there are symptoms that need relief, an acutely prescribed palliative remedies can serve to soothe many symptoms common at the end of life.5
End-of-life care using homoeopathic medicine as a palliative can be a valuable treatment when relief and comfort for a dying patient is needed. The problems that arise at the end of life do not always have to be drugged away or suffered through. Homoeopathic remedies can ease these symptoms and significantly reduce or preclude the need for pharmaceutical drugs, thereby prolonging the quality of life and meaningful interaction with loved ones in the last days.5
Conditions where palliation is used in homoeopathy
The basis of a homoeopathic cure is the fundamental law of similars. Similarly, the law of similars is also the fundamental law in the palliation of incurable states. Either for palliation of incurable diseases or for the cure of the curable diseases the symptomatology of the remedy must simulate, in so far as possible, the disease picture in order to bring relief. In incurable cases, or seemingly incurable cases also, the simillimum will so completely meet the situation as to obliterate the symptomatology of disease and the pathology, and will restore the patient to health.6
As per Dr HA Roberts6, palliation by homoeopathic medicines is justifiable in the following type of incurable cases:
- In advanced cases with irreversible pathological changes: Administration of the similar remedy in these cases almost always ameliorates the situation, at least for the three or four days and usually for a longer period. Then we may have a return of symptoms, when the indicated remedy will be called into use again. Thus, the patients can be made much more comfortable.6
- In cases of insomnia: Insomnia may be treated with crude palliative measures so that the patient secures sleep, but at best this is an unnatural sleep; while if the insomnia is considered as a part of his symptomatic picture, and given its proper place in that symptomatology and the man himself is treated-not alone one or two symptoms-he will gain his natural, refreshing sleep and he himself will be improved in general health.6
- Pain: When the symptom of pain itself is complete, with the location, type, aggravations, ameliorations and concomitants (which may lie in the conditions of aggravation or amelioration but which are often from seemingly unrelated symptoms) a carefully selected remedy will relieve the pain promptly, and the patient will be much more comfortable and happier in general than with any narcotic.6
- Surgical cases: Homoeopathic medicines can act as substitute for narcotics in surgical cases, either before or after operation. Here the indicated remedy does excellent service, and the patient will go through the mental and physical distress very happily. These remedies will be indicated partly by the symptomatology of the patient and partly by the immediate causes of distress, such as lacerated wounds, strenuous vomiting, shock and incarcerated flatus.6
Role of the homoeopathic remedies
Remedies for common symptoms in the dying patient like, nausea, difficult breathing, excessive secretions and death rattle, insomnia, pain and emotional upsets like fear, grief, and anxiety can be instituted with success. Integrating homeopathic medicine treatment can reduce the amount of pharmaceutical drugging suffered by the patients. Homoeopathic treatments can be useful when given for several hours before resorting to conventional medications. No one wants to be in pain and this is a major concern at end of life. Homoeopathic remedies will not stupefy or dull the patient, nor will they constipate the bowels or depress the respiratory rate, as morphine will. Remedies will not need detoxification by an already overtaxed liver.5
Usefulness of few homoeopathic medicines
- Magnesia phosphorica can be tried for muscular pain, cramp, abdominal pain, and even headache.5
- If the person has just had surgery or an injury then Arnica montana is needed.5
- Of all the remedies known for helping a dying person, Arsenicum album is best known for soothing the fear of death, and is indicated when there is agitation, restlessness, thirst, great anguish, internal burning heat with external coldness and desire for warmth.5
- Relieving nausea and vomiting for a person near end-of-life is particularly helpful, because it is so common for patients to suffer with it. Ipecacuanha can be tried when nausea or vomiting occur, with a clear tongue. Another remedy could be Nux vomica when the tongue is coated and toxic looking.5
- China officinalis may be used for the weakness experienced afterwards from the loss of fluids.5
- Calcarea carbonica might help very sick people who are putting out lots of perspiration (diaphoresis)which happens when one is in shock or having a medical emergency.5
- Carbo vegetabilis is a great collapse remedy, known for great weakness with bluish lips, icy cold skin and cool breath. Though they are cold they want a draft of air.5
- “Breathing at end of life can become shallow and quickened, or slow and labored. The person may make gurgling sounds, sometimes referred to as the “death rattle.” These sounds are due to the pooling of secretions and an inability to cough them up. The air passing through the mucus causes this sound. The breathing pattern most disturbing to those present, called cheyne-stokes breathing, is marked by periods of no breathing at all followed by deeper and more frequent respirations. These respirations are common and result from decreased oxygen supply to the vital organs and a build-up of waste products in the body. This condition is not uncomfortable or painful for the dying person, although it may be unsettling to observe. The “death rattle” or cheyne-stokes breathing indicates that death is near. “if the person seems to be having laboured breathing, is wheezing or having asthmatic symptoms or burning pains, Arsenicum album usually helps. Arsenicum album is also known to help the anxiety around not being able to get a good breath. When secretions build up and create rattling in the chest, Antimonium tartaricum is the main remedy, especially when the person is very weak and becoming unresponsive.5
Our job at this time when a dying person has difficulty breathing is to speak gently and lovingly, and use gentle reassuring touch to ease fear. Do not panic. This can increase any fear that may already be present for the dying person.5
- If acute fear and panic occur, with or without the well-known symptom “predicts the time of death”, Aconitum napellus can be given. Aconite is the best remedy when a fearful panic has gripped the body and mind and the heart is racing, and the mind cannot relax itself away from the distressing thought pattern. They may have a look of fear in their eyes or be so tense that it is noticeable in their appearance.5
- Taking the cell-salt, Kalium phosphoricum, which is known to be a tonic for the nervous system, may help caregivers who feel tense, stressed and overwhelmed.5
- Insomnia can be helped by Coffea cruda, for alertness when it is time for sleep because they are wired and upset. Arsenicum album helps those who cannot sleep due to worry and fear and Ignatia amara helps a grieving person sleep.5
- We all end up facing the loss of a loved one at some point in our lives. Some losses come suddenly and shockingly; others may be expected, for example at the end of a long illness. But in either instance, the feelings of grief and sorrow can be just as strong. When the grief of the situation starts to overwhelm, homeopathic remedies can bring healing for the dying person as well as their loved ones. Ignatia amara is used during the acute, initial phase of grief immediately before and after death. The sooner it is given, the better—not to suppress the grief but to allow for better coping and avoiding consequences of prolonged grief on the body and mind. The intense grief of Ignatia amara can bring spasmodic weeping, sadness that is inconsolable and despairing, and contradictory feelings like acute rage. A silent grief, suffered inwardly, needs Ignatia amara also, and symptoms frequently include a lump in the throat. The effects of cumulative loss are known to be especially trying, when spouse, family and friends are lost and loneliness takes over.5
- Cocculus indicus is known to help those who have been care takers of the sick and now have grief and health problems.5
- Phosphoricum acidum is for grief when there is very low energy and debility of the nervous system.5
Homoeopathic treatment is based upon symptomatology of the patients.Although every dying person will have different symptoms and needs in this time, the family can keep their loved one more comfortable, and go through the stages of the dying process in a more holistic and conscious manner using homoeopathic remedies. A motivated family can take charge and integrate customised palliative treatment using homeopathy into the care plan, which may allow the dying person to need less drugging. Homoeopathic alternatives to symptom suppression using drugs can be found for almost every situation. The fact that homeopathic medicines do not interact with drug treatment is a real plus and can be easily integrated with allopathic medical regimens. Homoeopathy should be offered as a modality option from all hospices.5
- Das E. Principles of prescribing [Internet]. Zahid; 2015 Dec 17 [updated 2015 Dec 17; cited 2022 May 17]. Available from: https://www.nhp.gov.in/Principles-of-Prescribing_mtl
- Frequently asked questions [Internet]. [cited 2022 May 17]. Available from: https://www.theaahp.org/consumer-information/faqs/
- About homoeopathy [Internet]. [updated 2017 Sep 20; cited 2022 May 17]. Available from: https://www.ccrhindia.nic.in/index1.aspx?lsid=1671&lev=2&lid=610&Regid=0&langid=1
- Sarkar BK. Organon of Medicine by Samuel Hahnemann. 10th ed. Delhi: Birla Publications Pvt. Ltd; 2005-2006.
- Bello L. End of life care- homoeopathy and hospice patients. Hpathy Medical Publishers [Internet]. 2015 Jan 17. [cited 2022 May 19]. Available from: https://hpathy.com/homeopathy-papers/end-of-life-care-homeopathy-and-hospice-patients/
- Roberts HA. The Principles and art of cure by homoeopathy.New Delhi: IBPP.