Theconstitutional neglect of palliative care demands more than another governmentannouncement
Thereis a historical irony in Goa's relationship with Portugal which deservesexamination beyond the familiar debate surrounding passports, ancestry andmigration. A Goan born before 19 December 1961 may, subject to the applicablenationality law and registration requirements, have a pathway to Portuguesecitizenship. Yet, irrespective of nationality, the elderly citizen who remainsin Goa must depend upon the healthcare institutions of the State in which thatperson resides.
Whathappens when that citizen becomes bedridden, neurologically disabled anddependent upon prolonged medical assistance? The answer exposes a question thatthe Government of Goa has yet to confront with sufficient institutionalseriousness: where is the enforceable architecture of palliative care?
Thecomparison with Portugal is not intended to suggest that its healthcare systemis without deficiencies. Rather, it demonstrates how an issue of humansuffering has been elevated into a distinct legislative responsibility.
Portugal'sLaw No 52/2012, the Basic Law on Palliative Care, expressly regulates access topalliative care, defines the State's responsibilities and establishes theNational Network of Palliative Care. Its provisions recognise multidisciplinarytreatment, continuity of care, home-based services and assistance to informalcaregivers. The legislation treats palliative care as an organised component ofpublic healthcare rather than merely an administrative programme (Portugal,2012).
Goa,by contrast, has approached the subject principally through governmentprogrammes and policy initiatives. The State Palliative Care Policy waslaunched in February 2025, while the National Programme for Palliative Care wasalready being implemented through the healthcare administration. The Governmenthas subsequently reported substantial patient interactions and described Goa asa model in comprehensive palliative care.
But where is the correspondinglegislative guarantee?
Whereis the statutory framework defining the minimum services that an eligibleelderly patient may expect? Where is the legally identifiable responsibilityfor ensuring continuity of home-based care? What mechanism enables a family tochallenge the absence of a promised service? What obligation is placed upon theadministration to publish annual district-wise performance reports and disclosethe unmet demand?
Apolicy may express governmental intention. A programme may provideadministrative direction. Neither should be confused with an independentlyenforceable entitlement to a clearly defined service.
Theinadequacies of the system ought to be subjected to independent measurement andpublic regulatory scrutiny. The existence of legislation has not been treatedas proof of successful implementation.
Thatis precisely the accountability mechanism Goa requires.
ThePortuguese model provides an important conceptual distinction. Palliative careis not restricted to the final hours of life. Law No 52/2012 recognises seriousand advanced illness, suffering, continuity of treatment and support forfamilies. Its definition encompasses physical, psychological, social andspiritual suffering. The home is recognised as a legitimate setting for care,subject to the patient's needs and the availability of appropriate support.
InGoa, the family frequently becomes the principal healthcare institution when anelderly person suffers a debilitating stroke or prolonged neurologicalimpairment. The responsibility may extend to tracheostomy management, feedingarrangements, prevention of pressure injuries, infection monitoring, medicationand continuous nursing assistance. These are demanding responsibilities whichcannot reasonably be treated as an ordinary domestic obligation.
TheMaintenance and Welfare of Parents and Senior Citizens Act, 2007, alreadyrequires State Governments to expand facilities for treating chronic, terminaland degenerative diseases affecting senior citizens and to provide specifiedgeriatric facilities in district hospitals. Article 41 of the Constitution identifiesold age, sickness and disablement as circumstances requiring public assistance,while Article 47 places public health among the State's primary duties.
Theconstitutional concern is therefore not the absence of legal language. It isthe distance between the legal promise and the actual availability of care.
Thereis also an irony in the manner in which Portuguese nationality is discussed inGoa. The Goa, Daman and Diu (Citizenship) Order, 1962, recognised thehistorical transition of citizenship following liberation, while preserving amechanism for persons to elect their previous nationality. Portuguesenationality claims involving Goan birth records must nevertheless be assessedindividually; the historical date does not automatically confer a Portuguesepassport (Government of India, 1962).
Thepoint is not that a Portuguese passport should be treated as a healthcareentitlement. Nor should the right to healthcare be made dependent upon ancestryor nationality. It is that the historical relationship invites a legitimatecomparison of how two public systems conceptualise the dignity of an ageingperson.
Goa'sGovernment has been capable of presenting elevated corridors as symbols ofdevelopment. It must now demonstrate comparable seriousness in developing theless visible infrastructure of human care: trained personnel, functionaldomiciliary teams, district-level services, essential medicines, caregiverassistance and reliable referral mechanisms.
TheGovernment's claim of being a model in palliative care should be tested againstindependently verifiable evidence, not beneficiary totals alone. The number ofpatients registered cannot establish whether a bedridden elderly personreceived continuous care, whether a caregiver was trained or whether anemergency request was answered.
TheGovernment should publish the minutes of its palliative care SteeringCommittee, disclose programme expenditure and establish measurable standardsfor domiciliary services. More importantly, Goa requires serious considerationof a dedicated legislative framework, drawing upon the institutional principlesof Portugal's Law No. 52/2012 while adapting them to India's constitutional andhealthcare structure.
TheDirective Principles cannot remain decorative constitutional aspirations,invoked during public celebrations of development and forgotten when citizensbecome dependent upon the State.
Theelderly Goan who cannot walk, speak or independently seek medical assistancehas no less claim to dignity than the citizen whose mobility is facilitated bya newly constructed corridor.
Portugal'slegislative experience demonstrates that palliative care can be recognised as adistinct public responsibility. Its implementation failures demonstrate thatlegislation must be accompanied by transparent scrutiny. Goa needs both.
Apassport may establish a person's connection with another nation. But nopassport should be necessary to secure the dignity of growing old in one's ownhome.
