End-of-life care policy: An integrated care plan for the dying

Abstract

Purpose:The purpose was to develop an end-of-life care (EOLC) policy for patients who are dying with an advanced life limiting illness and to develop practical procedural guidelines for limiting inappropriate therapeutic medical interventions and improve the quality of care of the dying within an ethical framework and through a professional and family/patient consensus process.Evidence:The Indian Society of Critical Care Medicine (ISCCM) published its first guidelines on EOLC in 2005 [1] which was later revised in 2012.[2] Since these publications, there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed observational studies, surveys, randomized controlled studies, as well as guidelines and recommendations, for education and quality improvement published across the world. The search terms were: EOLC; do not resuscitate directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; EOLC in India; cultural variations. Indian Association of Palliative Care (IAPC) also recently published its consensus position statement on EOLC policy for the dying.[3]Method:An expert committee of members of the ISCCM and IAPC was formed to make a joint EOLC policy for the dying patients. Proposals from the chair were discussed, debated, and recommendations were formulated through a consensus process. The members extensively reviewed national and international established ethical principles and current procedural practices. This joint EOLC policy has incorporated the sociocultural, ethical, and legal perspectives, while taking into account the needs and situation unique to India.

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

“…The descriptions include “no reasonable chance of benefiting the patient,” “highly unlikely to result in meaningful survival,” and “the physician must be certain that the intervention will fail to accomplish its intended goal.” Medical futility can be quantitative, qualitative, physiologic, lethal condition and imminent demise futility (Myatra et al ., 2014[32]).…”

“…The Law Commission of India has made a definite distinction between euthanasia and end of life decision about foregoing life support interventions. The decision could be made by the patient having the capacity to make this decision but not by the family on behalf of the patient (Myatra et al ., 2014[32]).…”

Do we need a more inclusive model for understanding Ethics in palliative care in the developing countries?

“…This has made pain management a very difficult issue. This problem has been further exaggerated by the lack of awareness amongst professionals regarding pain associated with end of life [9,10,11]. Another aspect is home care in the traditional societies where the family and the patient would prefer home care over hospitalization.…”

“…The guidelines issued by Indian Society of Critical Care Medicine (ISCCM) and the Indian Association of Palliative Care (IAPC) are definitely a major step towards the establishing of the ethical guidelines [11] in India. Similar steps are required by other concerned organizations of other countries too.…”

“…The movement of palliative care is fairly new in the developing countries like India, Pakistan and some Middle Eastern countries [9][10][11][12].A mapping project was commissioned by the Worldwide Palliative care Alliance to present the development of palliative care services in the world. The report placed Afghanistan, Bhutan and Maldives in group 1(no known activity), Pakistan, Bangladesh and Sri Lanka in Group 3a (isolated palliative care provision) and India and Nepal in Group 3b (generalized palliative care provision) [13].…”