75-90 percent of those dying in the ICU's of Europe and America do so with a treatment limiting decision and contrast this with India where hardly there is anything close to well documented decision making.
In an interview with ETHealthworld,Dr Raj K Mani, Chairman ELICIT, CEO, Nayati Hospital, Mathura, talks about challenges associated with end of life care and euthanasia. Edited excerpts:
What are the highlights of the Mathura Declaration?
The issue in India has been under debate for close to two decades but not much progress has been made. This is because of the great confusion in terminologies relating to end of life care and the principles and policies that are yet to develop.
Against this background there was a meeting consisting of multispecialty and multi-professional participants and the proceedings were designed in a way to generate brain storming on various contentious and ambiguous issues in our midst. For an issue of such public importance, a broad consensus, participation and capacity building is required. So the agenda consisted of certain essential needs of the terminally ill person that need further exploration.
What we as a society and we as professionals can contribute towards its improvement through debate and discussion, formulation of policy and finally construct a legislation. With this purpose, the professional group called ELICIT came together with the citizen’s forum called CANDID (citizen’s actions needing dignity in death).
The meeting concluded with the Mathura declaration in enunciating the call for action to the public, to professionals and to the government for focus on end of life issues.
What are the issues that you see around end of life care?
The issues are around knowing when to apply interventions, there needs to be medical, ethical and legal guidance to set limits to such treatments, when not to apply and when to remove, if applied and found to be futile. There are many contentious issues that are linked to these questions. When do we recognise that interventions are with reasonable degrees of certainty, not useful or become burdensome? Who decides? Who would monitor? How we can regulate this process? These are the questions that were explored in this meeting.
Much of this has been confused with the term euthanasia which has stopped evolution in this field in the last two decades or so. We have misunderstood going by the media discourse the true meaning of Euthanasia. It is not a broad term wherein any form of treatment refusal is defined as euthanasia. It is the actual killing of the patient, intending to do an act of mercy by a medical professional.
The broader term end of life care includes several ways of reasonable treatment limitation. The decisions like DNR, withholding and withdrawn has been an everyday practise in the western world for the last 30 years. 75-90 percent of those dying in the ICU's of Europe and America do so with a treatment limiting decision and contrast this with India where hardly any have this well documented decision making.
Tell us about the efforts that have been made in this direction?
Decision making in a standardised way comes with a frequent dialogue between the treating team and the patient if capable or with the family if the patient is not competent to do so. Through this process of dialogue a shared decision making is arrived at.
The laws in many parts of the world enable this process and put it within a well defined frame work. So the doctors can act ethically and effectively in the end of life phase for the patient.
We must also work towards creating a contemporary legal framework in our country. This process is on. The Ministry of Health and Welfare last year called for its draft bill on passive Euthanasia.
We should abandon confusing terms and take to contemporary terminology and definitions since this process requires advocacy at several professional and citizen’s levels. There was a group of processions termed ELICIT who took the first step in this direction. It is the acronym for end of life in India taskforce which brought together three medical associations; Indian Society of Critical Care Medicine, Indian Association of Palliative Care and Indian Academy of Neurology.
Original Article can be viewed here: