Definition of terms used in limitation of treatment and providing palliative care at the end of life: The Indian council of medical research commission report

Abstract

Background:Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date.Methodology:This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research. The consensus statement was created using Nominal Group and Delphi Method.Results:Twenty-five definitions related to the limitations of treatment and providing palliative care at the end of life were created by reviewing existing international documents and suitably modifying it to the Indian sociocultural context by achieving national consensus. Twenty-five terminologies defined within the scope of this document are (1) terminal illness, (2) actively dying, (3) life-sustaining treatment, (4) potentially inappropriate treatment, (5) cardiopulmonary resuscitation (CPR), (6) do not attempt CPR, (7) withholding life-sustaining treatment, (8) withdrawing life-sustaining treatment, (9) euthanasia (10) active shortening of the dying process, (11) physician-assisted suicide, (12) palliative care, (13) EOLC, (14) palliative sedation, (15) double effect, (16) death, (17) best interests, (18) health-care decision-making capacity, (19) shared decision-making, (20) advance directives, (21) surrogates, (22) autonomy, (23) beneficence, (24) nonmaleficence, and (25) justice.

Práticas de cuidado hospitalares no final de vida: revisão integrativa

“…Nesse sentido, ao retirar tratamentos mantenedores da vida, deve-se considerar os desejos do paciente com doença em estágio terminal e/ou de sua família (Salins et al, 2018). Trata-se de uma decisão influenciada pela especialidade do médico e, inclusive, como demonstrado nesta revisão, pela idade e sexo dos pacientes.…”

End of life care in end-stage kidney disease

“…According to the Indian Council of Medical Research (ICMR), potentially inappropriate treatment is defined as “clinical interventions that carry far greater possibilities of harm than reasonable possibilities of benefit.”[ 7 ] The Gold Standards Framework Proactive Identification Guidance (GSF-PIG) 6 th ed.ition published in 2016[ 8 ] has provided a framework for identifying people with end stage kidney disease approaching end of life. GSF-PIG has three steps.…”

Terminality Advance Directives and Nursing Practice in Brazil: Bioethical Issues

“…It is suggested that advance care planning initially includes information about the types of life-sustaining treatments available and decisions about the types of treatment that patients would or would not want if they were diagnosed with a life-limiting illness. Afterward, it is necessary to encourage the sharing of personal values by patients and their families, and only then the ADs should be written, expressing what kind of treatment they would like or not if they could not speak for themselves [18].…”

“…If the patient does not have the cognitive conditions to decide, it is suggested that the substitute decision-maker meets the following criteria: being able to make a decision, being available and willing to do so, and being legally established as representatives of the patient. In the absence of a legally established representative for decision-making, the next of kin may be considered a substitute [18].…”