India’s apex medical research body, Indian Council of Medical Research (ICMR), is attempting to address a grey area in medical care by drafting guidelines to stop doctors from reviving the terminally ill, whose resuscitation is non-beneficial and only causes further suffering.
The guidelines, aim to arm doctors to deal with the complex question– when to give up– without being binding. A nationwide consultation with all stakeholders including patient groups will begin in the first week of December before the policy is finalized.
An expert group discussion on the proposed policy, aptly named, ‘Do Not Attempt Resuscitation (DNAR) guide’, was held in Delhi on Monday.
“This policy document is meant to help doctors decide whether they should or shouldn’t attempt cardiopulmonary resuscitation (CPR),” said Dr Balram Bhargava, director general of the ICMR.
It will apply to situations when doctors feel revival of patients with incurable condition will be inappropriate, non beneficial, aggravate suffering and interrupt the natural dying process, says the draft.
The policy document seen by HT also lays down the protocols for communicating the decision to not revive such patients on a case to case basis.
Dr Roli Mathur, who is a senior scientist with ICMR and one of the experts working on the guidelines, says DNAR policy is meant to better equip doctors to manage a complicated scenario– when a patient’s death seems inevitable.
“The DNAR guidelines are meant to empower treating physicians to manage a complicated case scenario where resuscitation only increases a patient’s pain. It’s a grey area that hasn’t been covered under any court ruling so far,” said Dr Mathur.
She added that the guidelines will apply to “all cases” of cardiac arrest where a treating physician feels there is absolutely “no hope” of improving a patient’s quality of life but makes an attempt to revive anyway.
In the West, there are set protocols for such cases,” Dr. Mathur said.
Head of cardiology at AIIMS, Dr VK Bahl said the DNAR guide was covering a complex idea. “Brainstorming is always good but the DNAR is a complicated idea as the consent of the patient and the family plays a big role in the final decision,” he said.
Dr Ashok Seth, chairman of Fortis Escorts Heart Institute said the new policy will help the doctors take a decision when faced with the ultimate dilemma.
“We are often in a fix while dealing with cardiac arrest patients, whose other vital organs have either failed or were failing. In about 50% of these cases, relatives tell us not to resuscitate because there’s no hope of revival. It’s not just an emotional issue but also a huge financial burden on families. It (the policy) will help patients, relatives as well as the doctors,” said Dr. Seth.
Last year, the ICMR had released a guide defining conditions when physicians can withdraw life sustaining treatment for the terminally ill.