In a path-breaking partnership, the Indian Association of Palliative Care (IAPC) and the Indian Society of Critical Care Medicine (ISCCM) have joined hands with the objective of achieving excellence in end-of-life care. The integrated care plan, published in the Indian Journal of Critical Care Medicine, comes four years after a study of quality of death in 40 countries placed India at the bottom.
The 2010 report on this study commissioned by Lien Foundation and conducted by the Economist Intelligence Unit lamented the “incalculable surfeit of suffering, not just for those about to die, but also for their loved ones. Clearly, the deeper inclusion of palliative care into broader health policy, and the improvement of standards of end-of-life care—raising the ‘quality of death’—will also yield significant gains for humanity’s quality of life.”
In a companion editorial in the Indian Journal of Critical Care Medicine (IJCCM), Dr Raj Kumar Mani has regretted that the “debate on the issues around terminal care in our country has been hijacked by opinionated discussions on euthanasia.”
Summary of guidelines
- Recognise medical futility and the dying process based on the physician’s objective and subjective assessment.
- Physician to make an honest, accurate, and early disclosure of the poor prognosis of the patient to the family and the patient.
- Discuss and formulate consensus decisions among caregivers about poor prognosis and initiate an end-of-life care (EOLC) discussion.
- Communicate modalities of limiting life-prolonging interventions (including DNR, and withholding and withdrawal of life support).
- Respect choices made by the patient and hold open and repeated discussions about ongoing care.
- Faithfully record all discussions and decisions in the case papers.
- Once goal of care shifts from cure to comfort, the treatment team must focus on keeping patient pain-free and comfortable, and limiting life-prolonging interventions.
- After preparing the patient, the family and members of the treatment team, initiate withholding or withdrawal of life support.
- Manage non-physical issues such as psychological, emotional, spiritual, and existential distress through effective palliative care. Respect patient’s preference regarding place of care.
- After death, provide care that is culturally appropriate and sensitive.
- Provide bereavement support to help family and care givers cope.
- Review the care process as a quality assurance activity.