'End-of-life care needed for patients'

Death must come to all of us one day, and we all desire that it be peaceful and dignified. However, in today’s world, death may no longer be a peaceful transition, but could be complicated by medical interventions.

Critical care specialists in the capital reckon that taking the right call on an ‘end-of-life care’ is vital to provide relief to terminally ill patients with no hope of recovery.

They said imposing treatments on patients when there is no cure is actually prolonging a painful physical and mental trauma not only on the patient, but a mental agony and financial burden on the family of the patient.

“One could keep the lungs breathing and the heart ticking or the blood flowing pointlessly for long periods. The very same tools that help save a life, if misapplied could merely serve to prolong the dying process,” said Dr R K Mani, former director of critical care, pulmonology and sleep medicine at Saket City Hospital.

“The call is to limit such interventions through withholding or withdrawal of life support. This rational and humane approach is embodied in the term end of life care that focuses on less interventional, comfort-oriented care,” added Dr Mani.

“This is clearly distinct from any form of euthanasia, which connotes an act that intends to kill the patient. Active euthanasia is nothing other than administration of a lethal injection by the physician,” he adds.

He says that euthanasia only applies to a conscious person who’s very ill and asks a doctor to inject him because he feels it’s intolerable.  

Dr Rajesh Chawla, ex-president of Indian Society of Critical Care Medicine (ISCCM), further adds that there has been a tendency to use the term euthanasia loosely resulting in a lot of confusion.

“The medical profession does not endorse euthanasia, but wishes to draw the attention of the public to a more important issue which is referred to as end of life care,” he said.

“Actually, euthanasia refers only to putting an end to somebody’s life as an act of mercy through injection of a lethal drug,” Dr chawla said.

“Not to intervene when patient is facing death and is unlikely to benefit from aggressive treatment has been really nothing to do with this practice as understood in the current terminology,” he added. 

He highlights that end of life care and decisions made around terminal illness are emotive issues for patients, families and care givers. “The quality of end of life care that our patients receive is an important indicator of the health in our society,” Chawla said.
Unfortunately, India figured 39th in a list of 40 countries evaluated for “quality of death” in an international study conducted by the Economic Intelligence Unit in 2012. 

Around the world, there has also been a movement away from applying aggressive treatment to persons dying from incurable diseases. By current estimates, such deliberate withholding or withdrawal of life support happens in 75-90 per cent of ICU deaths.

“This practice is called limiting life support or foregoing of life support that is applied with appropriate legal framework in some countries through legislation,” said Dr Yash Javeri, secretary of ISCCM. In contrast, in India, the legal framework required for foregoing of aggressive treatment has taken time to develop because of misunderstandings relating to end of life issues.

The Supreme Court has appointed a five-judge constitution bench to explore the issues around advance will and end of life care in a petition. It has directed the states to submit their opinions and has also called for a public debate.

Recently, Union Health Minister Dr Harsh Vardhan had also said that euthanasia was a complex issue and opinions on it being made legal should be discussed before arriving at any consensus.

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