The image that you see is a patient of brain tumor sent back home due to advanced stage, and was suffering at home with severe pain and passed away in pain. He needed  basic palliative care support which could reach him in his village. Palliative care is an essential component of holistic healthcare, especially for patients in advanced stages of illnesses such as cancer. However, there remains a significant gap in the undergraduate medical curriculum in India concerning the pharmacological management of palliative care patients leaving such patients to suffer in pain and experience undignified death. This gap impacts the quality of care provided by medical professionals to patients with chronic and terminal illnesses. A lot of times patients in advanced stages of cancer are sent home from Specialised oncology centres and the relatives are asked to consult the local doctors in the city or town. A lot of the local doctors in town or villages might be doctors with MBBS degree where they were not taught about dealing with palliative care or end of life care patients and usage of oral morphine or fentanyl patches for palliative care/ end of life care patients and a lot of such patients receive a very undignified death without adequate symptomatic pain relief or relief from terminal breathlessness. This gap needs to be addressed. A 'physician of first contact' must know how to support a palliative care patient or end of life care patient and usage of oral morphine.

The National Medical Commission (NMC) holds the key to shaping and enhancing medical education in India as well as improving the quality of care to patients with life limiting illnesses. We urge the NMC to integrate a dedicated competency on Palliative Care Pharmacology into the undergraduate medical curriculum. This competency should not only impart knowledge but also cultivate essential skills related to the use of oral morphine and fentanyl patches in advanced cancer patients or other patients suffering with life limiting illnesses. Apart from this other essential palliative care drugs should also be taught to an undergraduate Medical Student in a separate chapter ' Palliative Care Pharmacology' in the subject of Pharmacology so that the medical student is equipped with knowledge and skills to adequately address issues of patients with life limiting illnesses.

Undergraduate medical students must learn the precise methods for prescribing and administering these critical medications, which are often at the forefront of palliative treatment plans. Understanding the conversion ratios between oral morphine and fentanyl, as well as effectively determining rescue doses, is vital for ensuring patient comfort and quality of life and is of utmost importance to offer a dignified life to such patients. These skills will empower young medical professionals to provide more compassionate and effective care, ultimately improving patient outcomes.

The introduction of this competency would address the current educational gap and align the medical curriculum with the practical demands faced by future doctors. It would also align with global practices, where palliative care pharmacology is increasingly viewed as fundamental in medical training.

We call upon the NMC to take immediate action to adapt the curriculum, ensuring that it reflects the importance of 'palliative care pharmacology'. By doing so, we can ensure that our medical graduates are not only knowledgeable but also empathetically skilled, ready to tackle the challenges of caring for patients with life-limiting conditions.

Please sign this petition to advocate for a future where our doctors are better prepared to provide comprehensive care for patients in their time of greatest need. Together, let's advance medical education and improve patient care across India.

We request NMC to involve Palliative care trained Pharmacologists, Palliative care Clinicians and other experts to further design the competency, learning objectives, domains-knowledge, skill, attitude for this much needed competency in Pharmacology. Please take it as an urgent humanitarian need for the India's patients suffering from life limiting illnesses and facing an undignified death as our physician of first contact does not know how to adequately use strong pain killers in the field.

Please consider this as a humble request to Pharmacologists, Anesthetists, Oncologists, Medical Doctors from any specialty and any common man who understands the purpose and spirit of this petition. Please sign and spread further.

 Hoping to be heard, by the NMC please. Your support to palliative care patients matters a lot.

Regards

Dr Aditi Chaturvedi, Professor Pharmacology, Pandit Jawahar Lal Nehru Government Medic College, Chamba, Himachal Pradesh.

Dr Sandip Mukhopadhyay, ICMR-National Institute for Research in Bacterial Infections, Kolkata, West Bengal.

Dr Rangeel Singh Raina, Professor and Head, Department of Pharmacology, Government Medical College, Dehradun, Uttarakhand.

Dr Sushma Bhatnagar, Head of Oncoanesthesia unit  and Palliative Care Consultant, AIIMS, New Delhi.

Dr MR, Rajgopal, ex-Director, Trivandrum Institute of Palliative Sciences, WHO Collaborating Centre, Trivandrum, India.

Dr AK, Dewan, Head of Head and Neck Cancer Surgery, Rajiv Gandhi Cancer Institute, New Delhi, India.

Dr Taranjit Singh, Palliative Care Consultant, Ganga Prem Hospice, Raiwala, Rishikesh, India.

Dr Parveen Kumar Sharma, Professor and Head, Department of Pharmacology, Shri Lal Bahadur Shastri Government Medical College and Hospital, Mandi, and Controller of Examinations, Atal Medical and Research University, Nerchowk, Distt. Mandi, HP, India.