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. 2014 Sep;18(9):615-35.
doi: 10.4103/0972-5229.140155.

End-of-life care policy: An integrated care plan for the dying: A Joint Position Statement of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Association of Palliative Care (IAPC)

Sheila Nainan Myatra  1 , Naveen Salins  2 , Shivakumar Iyer  3 , Stanley C Macaden  4 , Jigeeshu V Divatia  1 , Maryann Muckaden  2 , Priyadarshini Kulkarni  5 , Srinagesh Simha  6 , Raj Kumar Mani  7
Affiliations

End-of-life care policy: An integrated care plan for the dying: A Joint Position Statement of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Association of Palliative Care (IAPC)

Sheila Nainan Myatra et al. Indian J Crit Care Med. 2014 Sep.

Abstract

Purpose: The purpose was to develop an end-of-life care (EOLC) policy for patients who are dying with an advanced life limiting illness and to develop practical procedural guidelines for limiting inappropriate therapeutic medical interventions and improve the quality of care of the dying within an ethical framework and through a professional and family/patient consensus process.

Evidence: The Indian Society of Critical Care Medicine (ISCCM) published its first guidelines on EOLC in 2005 [1] which was later revised in 2012.[2] Since these publications, there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed observational studies, surveys, randomized controlled studies, as well as guidelines and recommendations, for education and quality improvement published across the world. The search terms were: EOLC; do not resuscitate directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; EOLC in India; cultural variations. Indian Association of Palliative Care (IAPC) also recently published its consensus position statement on EOLC policy for the dying.[3].

Method: An expert committee of members of the ISCCM and IAPC was formed to make a joint EOLC policy for the dying patients. Proposals from the chair were discussed, debated, and recommendations were formulated through a consensus process. The members extensively reviewed national and international established ethical principles and current procedural practices. This joint EOLC policy has incorporated the sociocultural, ethical, and legal perspectives, while taking into account the needs and situation unique to India.

Keywords: Care of the dying; end-of-life care in India; medical futility; position statement; terminal care; withholding and withdrawing.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Representing the continuum of palliative care and end-of-life care in an illness trajectory (Modified from http://depts.washington.edu/pallcare/training/ppt.shtml)
Figure 2
Figure 2
End-of-life care process pathway[1] modified with permission
See this image and copyright information in PMC

References

    1. Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P. Limiting life-prolonging interventions and providing palliative care towards the end of life in Indian intensive care units. Ind J Crit Care Med. 2005;9:96–107.
    1. Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P, et al. Guidelines for end of life and palliative care in Indian intensive care units:ISCCM consensus Ethical Position Statement. Indian J Crit Care Med. 2012;16:166–81. - PMC - PubMed
    1. Macaden SC, Salins N, Muckaden M, Kulkarni P, Joad A, Nirabhawane V, et al. End of life care policy for the dying: Consensus position statement of Indian Association of Palliative Care. Ind J palliat Care. 2014;20:171–81. - PMC - PubMed
    1. Jayaram R, Ramakrishnan N. Cost of intensive care in India. Indian J Crit Care Med. 2008;12:55–61. - PMC - PubMed
    1. Mani RK. Limitation of life support in the ICU. Indian J Crit Care Med. 2003;7:112–7.

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