New Guidelines for Stopping Life Support in Terminally Ill Patients in India
The Union Health Ministry of India has released draft guidelines for the withdrawal of life support in terminally ill patients. These guidelines emphasize that the decision should be carefully considered by doctors, taking into account the patient’s medical condition and overall health.
Key Points of the Guidelines
The guidelines outline four main conditions for withdrawing life support:
- The patient must be declared brainstem dead as per the Transplantation of Human Organs Act (THOA), 1994.
- Medical prognostication must indicate that the patient’s condition is advanced and unlikely to benefit from aggressive treatment.
- The patient or their surrogate must document an informed refusal to continue life support.
- There must be compliance with procedures prescribed by the Supreme Court.
The guidelines also state that doctors should not start life support measures in terminally ill patients if it is unlikely to benefit them and may cause suffering and loss of dignity.
Feedback and Opinions
The Union Ministry has invited feedback and suggestions on the draft guidelines by mid-next month. Dr. Asokan, President of the Indian Medical Association (IMA), mentioned that these responsibilities are already part of daily clinical practice and are shared between patients, relatives, and doctors. Dr. Rajeev Jayadevan, Past President of IMA Cochin, added that ICU care is essential for many life-threatening conditions, but there is a point where life support measures may no longer be beneficial.
Additional Details
The draft guidelines also address Do-Not-Attempt-Resuscitation (DNAR) decisions, stating that CPR may be withheld if there is no realistic chance of survival. The guidelines emphasize the importance of autonomy, privacy, and dignity for patients, and outline the legal principles for withholding or withdrawing life support.
For patients without decision-making capacity, a Primary Medical Board (PMB) of at least three physicians must make the proposal to forego life support, which must then be validated by a Secondary Medical Board (SMB) of three physicians, including one appointed by the Chief Medical Officer (CMO) of the district.
The guidelines clearly state that active euthanasia is not lawful.
Doubts Revealed
Union Health Ministry -: The Union Health Ministry is a part of the Indian government that looks after health policies and programs in the country.
draft guidelines -: Draft guidelines are a set of rules or instructions that are proposed and not yet final. They are shared to get feedback before becoming official.
withdrawing life support -: Withdrawing life support means stopping medical machines and treatments that keep a very sick person alive when they cannot get better.
terminally ill patients -: Terminally ill patients are people who have a disease that cannot be cured and will lead to death.
brainstem death -: Brainstem death is when the brainstem, which controls basic life functions like breathing, stops working permanently.
advanced medical prognostication -: Advanced medical prognostication is when doctors use their knowledge and tools to predict how a disease will progress and what the outcome will be.
informed refusal -: Informed refusal is when a patient or their representative understands the medical situation and decides not to receive certain treatments.
surrogate -: A surrogate is a person who makes medical decisions for a patient who cannot make decisions for themselves.
Supreme Court procedures -: Supreme Court procedures are the rules and steps set by the highest court in India for legal matters.
Do-Not-Attempt-Resuscitation (DNAR) -: DNAR is a medical order that tells doctors not to try to restart a patient’s heart or breathing if they stop.
patient autonomy -: Patient autonomy means that patients have the right to make their own medical decisions.
privacy -: Privacy means keeping a person’s personal and medical information safe and not sharing it without permission.
dignity -: Dignity means treating someone with respect and valuing their worth as a person.
