End of life care policy for the dying: Consensus position statement of indian association of palliative care

Abstract

EXECUTIVE SUMMARYPurpose:To develop an End of Life Care (EOLC) Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives.Evidence:A review of Country reports, observational studies and key surveys demonstrates that EOLC in India is delivered ineffectively, with a majority of the Indian population dying with no access to palliative care at end of life and essential medications for pain and symptom control. Limited awareness of EOLC among public and health care providers, lack of EOLC education, absent EOLC policy and ambiguous legal standpoint are some of the major barriers in effective EOLC delivery.Recommendations:Access to receive good palliative and EOLC is a human right. All patients are entitled to a dignified death. Government of India (GOI) to take urgent steps towards a legislation supporting good EOLC, and all hospitals and health care institutions to have a working EOLC policyProviding a comprehensive care process that minimizes physical and non physical symptoms in the end of life phase and ensuring access to essential medications for pain and symptom controlPalliative care and EOLC to be part of all hospital and community/home based programsStandards of palliative and EOLC as established by appropriate authorities and Indian Association of Palliative Care (IAPC) met and standards accredited and monitored by national and international accreditation bodiesAll health care providers with direct patient contact are urged to undergo EOLC certification, and EOLC training should be incorporated into the curriculum of health care education.

End-of-Life Care and Psychiatry: Current Trends and Future Directions in India

“…Eighty percent of these were in low- and middle-income countries (WHO, 2012[52]). In 2011, an estimated 20.4 million people worldwide needed palliative care at the end of life (Macaden et al ., 2014[25]). The common serious illnesses were cardiovascular diseases (38.5%), cancer (34%), chronic pulmonary diseases (10.3%), human immunodeficiency virus related (5.7%), and diabetes (4.5%).…”

“…The doctrine of double effect is applicable here and has been explained well by Macaden et al ., 2014, in their position paper[25] (it may be noted that although “double effects” are applicable to all the 4 ethical principles, with regard to EOLC, they are most obviously connected to nonmalfeasance). In EOLC, this applies to situations when to achieve adequate pain control using opioid analgesics and sedation, respiratory depression may result, which may shorten the dying process.…”

“…Advance care planning has been recommended as a part of the EOLC decision-making process in the position statement by the Indian Association of Palliative Care (IAPC)[25]. At the time of writing this article, the author has been informed that the National Accreditation Board for Hospitals has included a section on EOLC policy in the recent edition of their standards[33].…”

“…Patient choices, family collaborations, and discussions about end of life care are fraught with difficulties in EOLC (Macaden et al ., 2014[25]).…”

“…Although in an earlier case, law allowed the right to die when in a situation of excruciating suffering, the Indian Supreme Court later overturned this. These cases, however, related to suicide and attempted suicide and not to EOLC (Macaden et al ., 2014[25]). What does this mean and what does it imply?…”