Medical advisory to doctors soon on when to pull plug on life support

The Indian Council of Medical Research’s new glossary will become a reference point for doctors in determining limitation of treatment.

India’s apex medical research organisation will notify next month the conditions under which doctors can withdraw life-sustaining treatment for terminally ill patients.

In India, in an estimated 22-49% of the cases, treatment was withdrawn as it was not beneficial for the terminally-ill patients.

Once notified, the Indian Council of Medical Research’s (ICMR) new glossary will become a reference point for doctors in determining limitation of treatment and providing palliative care at end of life.

“The draft definitions are being reviewed before getting approved and notified in January,” said Dr Roli Mathur, who is supervising the project.

Withholding or withdrawing artificial life-support is different from euthanasia — or mercy killing — where life is ended actively and intentionally to relieve pain and suffering. Euthanasia is illegal in India.

A panel of experts set up by ICMR in January took eight months to draft the definitions based on accepted international definitions and national consensus.

“In most hospitals in India, patients are subjected to painful inappropriate life-sustaining interventions, while in US and in Europe withdrawal of inappropriate life-sustaining interventions preceded death in up to 90% of deaths in ICUs,” according to the draft.

In India, in an estimated 22-49% of the cases, treatment was withdrawn as it was not beneficial for the terminally-ill patients. “Anticipatory directives and advance care planning are non-existent,” said the ICMR document.

“There is a lot of confusion over terms such as ‘actively dying’, ‘sustaining life support’, ‘do not attempt to resuscitate’ etc. It has become a grey area as people tend to confuse it with euthanasia, which is illegal. We have several court cases also going on currently around the issue,” said Dr Mathur.

“We had put the draft in public domain for comments and received several suggestions that have been incorporated in the document,” she said.