NEW DELHI: Putting the onus of deciding whether life support should be withdrawn from a terminally ill patient or not would impose undue stress on doctors, Indian Medical Association has said.
According to Dr R V Asokan, IMA’s national president, such clinical decisions have always been taken in good faith by doctors.
“Our job is to inform the patient or her or his family member about the condition and explain to them about the prognosis.After that, it is their call as to whether they want to continue life support or not. This guideline, however, intends to create a framework defining the role of doctors which is concerning for us,” he said.
The draft guideline put out by the health ministry for public comments on the issue suggests life support can be withdrawn from a terminally ill patient if both the primary board and the secondary medical board constituted by a hospital and the family or surrogate of the patient give their consent. It is applicable to patients who are terminally ill, and not expected to benefit from life sustaining treatments (LST) that include (but are not limited to) mechanical ventilation, surgical procedures, parenteral nutrition or extracorporeal membrane oxygenation (ECMO).
According to the guideline, the primary medical board (PMB) which must assess the inappropriateness of life support should consist of the primary physician and at least two subject experts with at least five years of experience. After that, the decision is to be verified further by the secondary medical board (SMB) which should consist of one registered medical practitioner (RMP) nominated by the CMO and at least two subject experts.
A member of the PMB cannot form part of the SMB. Additionally, the govt guideline suggests, the hospital may constitute a clinical ethics committee of multi-professional members for audit, oversight and conflict resolution.
Dr Sushma Bhatnagar, who heads the cancer centre at AIIMS, was also involved in the development of the govt guideline. She said, “In medicine, we all have learnt how to diagnose and how to treat but no one has taught us what should be our approach when end is inevitable. Thus, we keep treating a person even if we know that there is no chance of recovery. And finally the person may not survive even after we have provided all sorts of technologically-advanced treatment with best equipment at hand. Those could have been used for someone who could be cured.”
“This policy can help in better understanding of diagnosis and prognosis. Patients and family members will be able to make informed choices,” she added.
Source Agencies
