New Delhi: Doctors should take a “considered decision” on withdrawal of life support in terminally ill patients based on certain conditions, including written informed refusal by the patient or their relatives, according to draft guidelines. Is. Union Health MinistryFour conditions have been laid down in the guidelines passive euthanasia “To make a well-considered decision in the best interests of the patient, to withdraw or discontinue ongoing life support in an incurable disease that is no longer likely to benefit the patient or is likely to cause harm in the form of suffering and loss of dignity” Is.”
The conditions are whether the person has been declared brain system deathIf there is a medical prognosis and considered opinion that the patient’s disease state is advanced and unlikely to benefit from aggressive medical intervention, the patient/surrogate may, after awareness of the prognosis, choose to continue life support and comply with the procedure prescribed by the Supreme Court. Has refused. court.
The ‘Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients’ also states that doctors should take a conscious decision not to initiate life support measures in a terminally ill patient, taking into consideration the benefit of the patient Not likely to happen and likely to suffer from it. And loss of dignity.
In such a case, three conditions are considered – whether the person has been declared brainstem death, if there is a medical prognosis and consideration of whether the patient’s disease status is advanced and likely to benefit from aggressive medical intervention. No, written informed refusal by the patient/surrogate, adherence to prognostic awareness – need to be taken into account.
The Union ministry has invited feedback and suggestions from stakeholders on the draft by October 20.
The draft guidelines have not gone down well among members of the medical fraternity, with IMA national president Dr RV Asokan saying it brings doctors under legal scrutiny and puts them under stress.
“Such clinical decisions have always been taken by doctors in good faith. The patient’s relatives are explained and given all the information, in a given case they are taken into confidence and in every single case on the basis of competence. The decision is taken on the basis that it is put down as per the guidelines and to allege that unfair decisions have been taken or they have been delayed for a long time is a misunderstanding of the situation,” said Dr Ashokan.
“First of all the perception and perception that machines are used unnecessarily and life is prolonged is wrong. This brings doctors under the ambit of legal scrutiny.
He said, “Trying to define whatever is left of the doctor-patient relationship into four corners of black and white documents, which are legally scrutinized, is only going to put doctors under more stress.” There is nothing else.”
There are some things that should be left to relatives, patients and doctors based on science and the situation, Dr. Ashokan said.
Indian Medical AssociationDr. Ashokan said, will study the document and present his views seeking amendments in the draft guidelines.
The draft guidelines define terminal illness as an irreversible or incurable condition from which death is inevitable in the near future. Severe traumatic brain injury that shows no improvement after 72 hours or more is also included.
The draft document states that many patients in the ICU are terminally ill, and are not expected to benefit from life-sustaining treatment (LST), including mechanical ventilation, vasopressors, dialysis, surgical procedures, transfusions, parenteral nutrition or Are (but are not limited to). Extracorporeal membrane oxygenation.
“In such circumstances, LSTs are non-beneficial and increase avoidable burden and suffering on patients and are, therefore, considered excessive and inappropriate. Additionally, they cause emotional stress and economic hardship to the family and professional caregivers. Increase moral crisis.
“Withdrawal of LST in such patients is considered a standard of ICU care throughout the world and is upheld by many jurisdictions. There are medical, ethical and legal considerations in such decisions. It can be assumed that The above also applies at the time of starting life support treatment for individuals,” the draft said.
The draft calls for a considered decision not to perform cardiopulmonary resuscitation in the event of anticipated cardiac arrest if there is no realistic prospect of survival or meaningful recovery.
Accordingly, the legal principles outlined by the Supreme Court state that an adult patient capable of making health-related decisions can refuse LST, even if it would result in death.
Furthermore, according to the principles, based on the fundamental rights to autonomy, privacy and dignity, LST can be legally withheld or withdrawn under certain conditions from people who no longer retain decision-making capacity. advance medical directiveor AMD, which meets the specified requirements, is a legally valid document.
An AMD is a written declaration made by someone with decision-making capacity that documents how they would or would not like to receive medical treatment if they lose capacity.
For a patient without capacity, life support resolutions should be waived by consensus among a group of at least three physicians forming a primary medical board (PMB).
To fully inform the surrogate, the PMB must be informed about the disease, available medical treatments, alternative forms of treatment, and the consequences of being treated and untreated.
A secondary medical board of three physicians appointed by the Chief Medical Officer of the district will have to validate the decision of the PMB.
The draft document states, “Active euthanasia is the deliberate act of killing a terminally ill patient, upon voluntary request, by the direct intervention of a doctor for the purpose of promoting the patient’s well-being. It is illegal in India.”
