DOCTORS should take a “considered decision” on withdrawal of life support in terminallyillpatientson thebasis ofcertainconditionsincluding a documented informed refusal by the patient or their kin, according to draft guidelinesbyUnionHealthMinistry. The guidelines laid out four conditionsonpassiveeuthanasia for taking a “considered decision in a patient’s best interests, to stop or discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm in terms of causing suffering and loss of dignity.” The conditions are whether the individual has been declared brainstem death, if there is a medical prognostication and considered opinion that the patient’s disease condition is advanced and not likely to benefit from aggressive therapeuticinterventions, patient/surrogate documented informed refusal, following prognostic awareness, to continue life support and compliance with procedure prescribedby the SupremeCourt.

 

The ‘Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients,’ also state that doctors should take a considered decision to not start a life supportingmeasure in a terminally ill patient that isunlikely tobenefit thepatient and is likely to lead to suffering and loss of dignity. In such a case, three conditions — on whether the individualhasbeendeclaredbrainstem death, if there is a medical prognostication and considered opinion that the patient’s disease condition is advanced andnotlikely tobenefit from aggressive therapeutic interventions, patient/surrogate documented informed refusal, following prognostic awareness — has to be taken into account.TheMinistry has invited feedback and suggestions from the stakeholders on the draft by October 20. Thedraftguidelineshavenot gone down well among the members of the medical fraternity, with the IMA’s nationalPresidentDrRVAsokanstating it exposes doctors to legal scrutiny and puts them under stress.“Such clinical decisions havealwaysbeen takeningood faith by doctors.

 

The patient’s relatives are explained and given all information, taken into confidence ina given case and decision is taken on merit in every single case. Putting it down in sort of guidelines and also alleging that inappropriate decisions have been taken or they have been prolonged is misunderstanding the situation,” Dr Asokan said. “First the perception and assumption that unnecessarily machines are used and lives are prolonged is wrong. It exposesdoctors tolegalscruity. More so what is left of a doctor-patientrelationship...Trying to defineitin4 corners of black and white documentation which is legally scrutinised is nothing but exposing doctors to further stress,” he said.