India now has its first guidelines for taking “irrevocably-ill” patients off treatment and life support.
Senior doctors at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh and lawyers in the Punjab and Haryana High Court have together worked on guidelines for letting patients who have suffered brain stem death or are in deep coma die in dignity and peace.
By next week, all doctors in the hospital will receive the new guidelines.
The argument for the new recommendations is that patients with irreversible, end-stage diseases (where chances of recovery are negligible) should not linger for months on assisted ventilation. In doctors and lawyers’ opinion, “prolonging the miserable, vegetative life by trying futile invasive procedures amid disintegration of the body lowers the dignity of death”. It adds: “It (prolonging life with artificial support) is tough on the family— physically, financially and psychologically.”
Often, close relatives of the patient can foresee the outcome, yet they are unable to express and decide, doctors feel. “Medical opinion will help them (patients’ families) resolve the conflict in comfort and peace,” said Dr S.K. Jindal, head of PGI Department of Pulmonary Medicine, who had a key role in developing the guidelines.
On the legal front, the guidelines made clear the distinction between intentional killing and allowing a patient to die under “brain death” and “coma”, Jindal said. “On the moral front, physicians have the duty to make the end comfortable.”
A board of medical experts will recommend the final step only after proper evaluation, the guidelines say. The board will include a doctor-in-charge of the hospital in which the brain stem has died, an independent doctor from a panel of names that an appropriate authority has approved, a neurologist or neurosurgeon, and the doctor treating the patient.
After the evaluation, the board will explain the patient’s condition to at least two of his or her closest relatives.