The Ministry of Health & Family Welfare (MoHFW) on June 18, 2024, issued the Guidelines for Withdrawal of Life Support in Terminally Ill Patients.
Many patients in the ICU are terminally ill, and not expected to benefit from life sustaining treatments (LST) that include (but are not limited to) mechanical ventilation, vasopressors, dialysis, surgical procedures, transfusions, parenteral nutrition or Extracorporeal Membrane Oxygenation (ECMO). In such circumstances, LSTs are non-beneficial and increase avoidable burdens and suffering to patients and therefore, are considered excessive and inappropriate. Additionally, they increase emotional stress and economic hardship to the family and moral distress to professional caregivers. Withdrawal of LST in such patients is regarded as a standard of ICU care worldwide and upheld by several jurisdictions. Such decisions have medical, ethical and legal considerations. It may be considered that the above-mentioned also applies at the time of initiating Life support treatments to individuals with.
The Legal Principles Outlined by The Honorable Supreme Court:
• An adult patient capable of taking healthcare decisions may refuse LST even if it results in death
• LST may be withheld or withdrawn lawfully under certain conditions from persons who no longer retain decision-making capacity, based on the fundamental right to Autonomy, Privacy and Dignity
• AMD that meets specified requirements is a legally valid document
• For a patient without capacity, FLST proposals should be made by consensus among a group of at least 3 physicians who form the Primary Medical Board (PMB)
• The PMB must explain the illness, the medical treatment available, alternative forms of treatment, and the consequences of remaining treated and untreated to fully inform the surrogate
• A Secondary Medical Board (SMB) of 3 physicians with one appointee by the Chief Medical Officer (CMO) of the district must validate the decision by the PMB
• Active Euthanasia is not lawful.
Guidelines Will Be Available in The Public Domain for Public Comments for A Period of 1 Month.
