PALLIATIVE CARE AND HOMEOPATHY

Even When We Cannot Cure the Patient, There Is Still So Much We Can Do

When people hear the term palliative care, most immediately think of patients for whom there are no longer any treatment options and who are approaching the end of life.

But palliative care is so much more than that.

Palliative care means reducing a patient’s pain and distressing symptoms, maintaining quality of life as much as possible, respecting the patient’s wishes and values, and supporting both the patient and their family—even when it is no longer possible to completely eliminate the disease.

Unfortunately, this is still a developing field, not only in Turkey but in many countries around the world.

Thanks to advances in medicine, new medications, intensive care practices, and advanced technology, we can now prolong life in many diseases. Even when we cannot cure the disease, we can often help the patient live longer.

But this leads us to another question:

Does living longer always mean living better?

And perhaps even more importantly:

What does the patient want?

Asking What the Patient Wants

In the United States and some developed European countries, patients’ wishes regarding the final stage of their lives are discussed more openly, and efforts are made to develop care plans that respect those wishes as much as possible.

For example, a patient may say, “If my breathing stops one day, I do not want to be put on a ventilator.”

Within the appropriate legal and medical framework, this preference can be discussed in advance, documented, and respected as much as possible.

Some countries and some U.S. states have different legal regulations regarding end-of-life decisions. These are extremely complex ethical and legal issues.

But I believe that at the center of all these discussions there should be one very simple question:

“How does this person want to live?”

Because sometimes we physicians become so focused on the medical interventions we are capable of providing that we forget to ask what the patient actually wants.

Palliative Care in Turkey

In Turkey, the number of home-care and healthcare services, elderly care centers, and facilities providing more advanced levels of care is gradually increasing. However, I believe the need is still enormous.

I remember that when I was a child, people would sometimes say about certain patients, “There is nothing more we can do for this patient. Take them home and make them comfortable.”

Today, we hear this sentence much less often.

Because medicine has advanced.

We can do more.

But sometimes being able to do more does not necessarily mean that the patient will be more comfortable.

No one wants to see someone they love suffer. And for many families, managing a prolonged dying process at home, right in front of their eyes, can be overwhelming.

There are people who have to work.

There are people who have children to care for.

There are families who have no one else to provide care around the clock.

And sometimes, the person caring for the patient becomes just as exhausted as the patient themselves.

That is why I believe palliative care should not be provided only to the patient, but to everyone standing beside that patient.

First, We Need to Look at the Person’s Mind and Emotions

One of the things I consider most important in palliative care is how the patient feels, even before looking at their physical symptoms.

Are they afraid of death?

Do they not want to be alone?

Do they constantly need someone by their side?

Are they restless?

Can they accept death?

Or are they still unable to believe that it is actually going to happen?

Sometimes the patient’s greatest suffering is not pain.

It is fear.

Sometimes it is being alone.

Sometimes it is the question, “What is going to happen?”

And sometimes it is the feeling that they have completely lost control.

This is one of the areas where I believe the homeopathic approach can be meaningful.

Because in homeopathy, we do not look only at “What disease does the patient have?” We also look at how the patient experiences that disease.

Fear, Inability to Be Alone, and Arsenicum

I still remember one of my patients very clearly.

He was extremely frightened.

He never wanted to be alone in the room. If possible, he wanted the light to remain on.

I have never felt that simply describing such a patient as having “anxiety” was enough.

What is the patient afraid of?

What do they feel when they are alone?

What do they need in order to feel safe?

What is their restlessness like?

In this patient, Arsenicum album came to my mind.

In homeopathy, we do not associate Arsenicum only with fears. It is also one of the remedies considered in a variety of pictures involving nausea, vomiting, diarrhea, restlessness, exhaustion, and particularly a strong need for security.

We encounter these kinds of situations frequently in palliative care as well.

Delirium, Agitation, and Hallucinations

During the final days or hours of life, some patients may develop delirium.

The patient may become extremely agitated.

They may shout or call out.

They may see things that are not there.

They may fail to recognize people.

They may try to get out of bed.

Sometimes the restlessness becomes so severe that it may take three, four, or even five people to keep the patient safe.

I saw many such situations during my years in intensive care.

And I also know that sometimes we had to use significant sedation in order to calm the patient.

From a homeopathic perspective, depending on the individual picture, remedies such as Hyoscyamus and Belladonna may be considered.

Of course, I am not suggesting that homeopathy should replace necessary medical interventions. Particularly in patients with severe delirium, serious agitation, or a risk of harm, modern medical treatment should be used.

However, in appropriate patients, I believe homeopathy may provide complementary support for symptom management.

Facing Death Itself

As an experienced intensive care physician, I can say that throughout my career I have witnessed many people leaving this world.

And not everyone dies in the same way.

Some people accept death during their final days.

Some want to spend their last moments as peacefully as possible.

Others cannot accept it.

They are afraid.

They become agitated.

They experience delirium.

Sometimes the way a person spends their final hours becomes a memory that those left behind will carry for years.

For this reason, I believe that we need not only to be less afraid of death, but also to be able to talk about death.

Physical Symptoms

Alongside psychological and emotional distress, we can encounter very serious physical symptoms during the final stage of life.

Constipation, nausea and vomiting, pain, shortness of breath, oxygen requirements, pressure injuries, and weakness are just a few examples.

During the terminal stage, patients often take many medications. These medications themselves can cause nausea, vomiting, constipation, diarrhea, and other side effects.

Our goal here is not to eliminate necessary medications, but to reduce the patient’s overall symptom burden as much as possible.

Constipation

Constipation is one of the most common problems we encounter in patients who are bedridden for long periods.

Immobility, inadequate fluid and nutritional intake, and medications—particularly some strong pain medications—can make constipation worse.

In conventional medicine, these patients may be given laxatives and medications that regulate bowel movements.

From a homeopathic perspective, remedies such as Opium, Nux vomica, and Bryonia may be considered according to the patient’s overall picture.

Again, I believe homeopathy should not replace necessary medical treatment, but rather, when appropriate, accompany it as a complementary approach.

Nausea and Vomiting

Nausea and vomiting can also be extremely distressing for patients during the terminal stage.

Sometimes they are caused by medications.

Sometimes they result from the disease itself.

And sometimes they cannot be adequately controlled despite treatment.

In homeopathy, remedies such as Ipecacuanha and Arsenicum album may be considered according to the characteristics of the patient’s symptoms.

Again, the primary goal is the patient’s comfort.

Pain

One of the most important issues in palliative care is pain.

No one should be left in unnecessary pain.

When strong analgesics are needed, they should be used. We cannot accept a patient suffering simply because we want to use a homeopathic remedy instead.

However, in appropriate patients, the homeopathic approach may provide complementary support for pain management.

Here, we need to look not only at the intensity of the pain, but also at what the pain is like, what makes it better or worse, and how the patient experiences it.

Shortness of Breath and the Need for Oxygen

One of the most frightening physical symptoms in palliative care is shortness of breath.

For a patient with advanced lung disease, being able to walk even a few steps can be a tremendous achievement.

I can never forget one particular patient.

He was a gentleman with advanced lung cancer.

He was sitting with oxygen support.

One day he said to me:

“They pretend they’re not telling me, but I know. I’m dying. And I try not to let them know that I know. I pretend that I’m going to get better.”

Then he told me his greatest wish.

“I want to get rid of this oxygen. I want to be able to walk to the bathroom comfortably. And I want to go home and look outside through my own window.”

The hospital window did not look out onto anything.

It only faced the empty space between the buildings.

For him, simply being able to look outside through his own window was incredibly important.

At that time, I followed him with Stannum metallicum.

He improved enough to be weaned from his oxygen support and was able to go home.

About two or three weeks later, his condition deteriorated again and he was readmitted to the hospital.

But those few weeks were very precious to him.

Because what he wanted was not actually to “live longer.”

He wanted to go home.

To look outside through his own window.

To be able to go to the bathroom by himself.

Sometimes, this is exactly what palliative care is about.

Not prolonging life at any cost.

But making the time the patient has left meaningful for that patient.

Immobility and Pressure Injuries

Pressure injuries are also an important problem in patients who remain bedridden for long periods.

Perhaps the most important treatment here is actually very simple:

Regularly changing the patient’s position.

Checking the skin.

Providing appropriate nutrition.

Ensuring adequate fluid intake.

Reducing pressure points.

Cleaning and dressing the wound properly.

From a homeopathic perspective, remedies such as Calendula may be considered as complementary measures in some situations.

However, no homeopathic approach should replace appropriate wound care, treatment of infection, or surgical evaluation when necessary.

What Does “There Is Nothing More We Can Do” Really Mean?

Sometimes, when caring for a patient, we say, “There is nothing more we can do.”

I now try to hear this sentence differently.

Because:

“We can no longer cure the disease” is one thing.

“There is nothing more we can do” is something completely different.

We may not be able to cure the patient.

But we can reduce their pain.

We can listen to their fears.

We can ease their breathing.

We can reduce their nausea.

We can moisten their mouth.

We can reposition them.

We can hold their hand.

We can make sure their family can be with them.

And sometimes we can help them go where they want to be—to their own home.

All of these are also part of treatment and care.

CARE FOR THE CAREGIVER

Palliative care is a process in which not only the patient, but also the person caring for them, carries a tremendous burden.

Sometimes the caregiver’s exhaustion and burnout become an invisible form of suffering, just as real as the patient’s pain.

I always say:

In palliative care, the best medicine is love and compassion—and these should be given not only to the patient, but also to the person caring for them.

Caregiver burnout, guilt, sleep deprivation, physical exhaustion, and emotional collapse are very common.

For this reason, when appropriate, a complementary homeopathic approach may include evaluating not only the patient’s symptoms, but also the symptoms experienced by the caregiver.

Emotional Burden, Guilt, and Inner Collapse

“I’m not taking good enough care of them.”

“I wish I could do more.”

“Did I fail to do something?”

These thoughts are very common among caregivers.

Especially when someone takes responsibility for caring for a loved one, they may gradually forget about themselves.

In homeopathy, Ignatia is one of the remedies considered in situations involving sudden grief, emotional fluctuations, suppressed crying, and intense emotional distress.

Phosphoric acid may be considered in people who, after prolonged grief and the burden of caregiving, feel emotionally exhausted, completely drained, and as though all their energy has been taken away.

Again, I do not believe the remedy should be selected based simply on a single symptom such as “the caregiver is very sad.” We need to look at the person’s entire picture.

Insomnia, Hypervigilance, and Anxiety

A caregiver’s sleep is often interrupted.

They listen to every breath the patient takes.

They monitor every movement.

They remain constantly alert, thinking, “What if something happens?”

After a while, this can develop into significant mental and physical exhaustion.

Coffea is one of the remedies considered homeopathically when the mind is constantly active, thoughts become faster when the person goes to bed, and they cannot sleep.

Cocculus may be considered particularly in people who have become exhausted from sleep deprivation, have barely slept for days, and have had to provide care in shifts continuously.

“I stayed by their side all night. I finally managed to sleep toward morning, but an hour later I had to get up again.”

Sometimes, this is exactly what the caregiver’s story looks like.

Kali phosphoricum is also among the remedies considered in states of mental fatigue and nervous exhaustion.

Physical Exhaustion and Burnout

Sometimes the caregiver becomes more exhausted than the patient.

Positioning the patient throughout the day…

Feeding them…

Cleaning them…

Keeping track of their medications…

Getting up during the night…

Speaking with doctors…

Monitoring every change in the patient…

All of this is more than one person can reasonably carry.

Arsenicum album may be considered in states of physical and mental exhaustion accompanied by anxiety and restlessness.

Gelsemium may be considered when, following prolonged stress, the person feels, “I have completely lost my strength,” and experiences profound heaviness and fatigue.

But perhaps there is something that needs to be done even before homeopathy:

Do not leave the caregiver alone.

If there are other people at home who can help, care should be shared in shifts.

If possible, the day should be divided between two people.

One person can help at night and another during the day.

Because caregivers also need to sleep, rest, take a shower, go outside, talk to their friends, and return to their own lives—even if only for a few hours.

A person who is completely exhausted cannot provide healthy care to another person for a prolonged period of time.

And Sometimes the Best Care Is a Glass of Water

When we talk about palliative care, we talk about remedies, medications, oxygen, and painkillers.

But sometimes the best care is none of these.

It is giving the patient a glass of water.

Moistening their mouth.

Changing their position every two hours.

Covering them if they are cold.

Noticing when they are in pain.

Talking to them even if they are unconscious.

Holding their hand.

And making them feel that you are there.

Because we should never assume that just because a patient cannot speak, they cannot feel anything.

And Then There Was a Six-Week-Old Kitten…

Sometimes we learn what we know not only from human beings, but from other living creatures as well.

There was a six-week-old kitten.

It had suffered from feline distemper.

It was very sick.

Extremely weak and debilitated.

Honestly, we thought it was going to die.

I gave it Arsenicum because I did not want it to suffer any more.

It recovered.

And it has now been alive for three years.

This was a very powerful experience for me.

Because it reminded us once again:

Even at the moment when we say, “There is nothing more we can do,” sometimes there is still something we can do.

Maybe it is not curing.

Maybe it is simply making the patient more comfortable.

Maybe it is gaining a few days.

Maybe a few weeks.

Maybe it is simply reducing fear.

But that small difference can be enormous for the patient.

What Should Be at the Center of Palliative Care?

I think the answer is very simple:

The person.

Not the disease.

Not the test results.

Not the numbers on the monitor.

First and foremost, we need to see the human being.

What do they want?

What are they afraid of?

What do they need?

Whose company do they want?

Where do they want to be?

How much intervention do they want?

And perhaps most importantly:

How do they want to spend the time they have left?

Sometimes the answer is not more treatment in the hospital.

Sometimes the answer is home.

Sometimes it is family.

Sometimes it is sitting in front of an open window.

Sometimes it is keeping the light on.

Sometimes it is holding someone’s hand.

Final Thoughts

I know that the subject I am talking about today is one that many people do not want to hear, see, or accept.

Talking about death is not easy.

Talking about the final stage of life is not easy either.

But these people exist.

Thousands of people need care during the final stage of their lives.

And there are thousands of family members, doctors, nurses, and caregivers trying to be there for them.

I always try to support both my patients and the people who care for them.

I also believe that, in the right patient and in the right way, homeopathy may have a role as a complementary approach alongside necessary medical care, helping to reduce the symptom burden experienced by both the patient and the caregiver.