Guidelines for end-of-life and palliative care in Indian intensive care to units: ISCCM consensus Ethical Position Statement
P. Amin, R. Chawla, J. V. Divatia, F. Kapadia, P. Khilnani, S. N. Myatra, S. Prayag, R. Rajagopalan, S. K. Todi, R. Uttam
Citation Information :
Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P, Myatra SN, Prayag S, Rajagopalan R, Todi SK, Uttam R. Guidelines for end-of-life and palliative care in Indian intensive care to units: ISCCM consensus Ethical Position Statement. Indian J Crit Care Med 2013; 17 (S1):26-41.
Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P, et al. ISCCM position statement: Limiting life-prolonging interventions and providing palliative care towards the end of life in Indian intensive care units. Indian J Crit Care Med 2005;9:96-107.
Bone RC. You and I are dying. In: Reflections; a guide to end of life issues for you and your family. Evanston IL: National Kidney Cancer Association; 1997. p. 4-7.
Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 2004;32:638-43.
Parikh CR, Karnad DR. Quality, cost and outcome of intensive care in a public hospital in Bombay. Crit Care Med 1999;27:1754-9.
Rajagopalan RE. End of life care: New paradigms in management. Postgrad Med 2002;16:51-6.
Crippen D, Kilcullen JK, Kelly DF, editors. Three patients: international perspectives on intensive care at the end of life. USA: Kluver Academic Publishers, Mass; 2002.
Burns J, Edwards J, Johnson J, Cassem NH, Troug RD. Do-notresuscitate order after 25 years. Crit Care Med 2003;31:1543-50.
Koch KA, Rodeffer HD, Wears RL Changing patterns of terminal care management in an intensive care unit. Crit Care Med 1994;22:233-43.
Smedira NG, Evans BH, Grais LS, Cohen NH, Lo B, Cooke M, et al. Withholding and withdrawal of life support from the critically ill. N Engl J Med 1990;322:309-15.
Prendergast TJ, Luce JM. Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Resp Crit Care Med 1997;155:15-20.
Prendergast TJ, Claessens MT, Luce JM. A National Survey of End-of-life Care for critically ill patients. Am J Respir Crit Care Med 1998;158:1163-7.
Ferrand E, Robert R, Ingrand P, Lemaire F, French LA. TAEREA Group. Withholding and withdrawal of life support in intensive care units in France: A prospective study. Lancet 2001;357:9-14.
Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European intensive care units: The ETHICUS study. JAMA 2003;290:790-7.
Soares M, Terzi RG, Piva JP. End-of-life care in Brazil. Intensive Care Med 2007;33:1014-7.
Yazigi A, Riachi M, Dabbar G. Withholding and withdrawal of life sustaining treatment in a Lebanese intensive care unit: A prospective observational study. Intensive Care Med 2005;31:562-7.
Buckley TA, Joynt GM, Tan PY, Cheng CA, Yap FH. Limitation of life support: Frequency and practice in a Hong Kong intensive care unit. Crit Care Med 2004;32:415-20.
Weng L, Joynt GM, Lee A, Du B, Leung P, Peng J, et al. The Chinese Critical Care Ethics Group. Attitudes towards ethical problems in critical care medicine: The Chinese perspective. Intensive Care Med 2011;37:655-64.
Turner JS, Michell WL, Morgan CJ, Benatar SR. Limitation of life support: Frequency and practice in a London and a Cape Town intensive care unit. Intensive Care Med 1996;22:1020-5.
Eidelman LA, Jakobson DJ, Pizov R, Geber D, Leibovitz L, Sprung CL. Foregoing life-sustaining treatment in an Israeli ICU. Intensive Care Med 1998;24:162-6.
Gozalo P, Teno JM, Mitchell SL, Skinner J, Bynum J, Tyler D, et al. End of life care transitions among nursing home residents with cognitive issues. N Engl J Med 2011;365:13.
Garros D, Rosychuk RJ, Cox PN. Circumstances surrounding end-oflife care in pediatric intensive care units. Pediatrics 2003;112:e371-9.
Devictor DJ, Latour JM. The EURYDICE II study group. Forgoing life support: How the decision is made in European pediatric intensive care units. Intensive Care Med Intensive Care Med 2011;37:1881-7.
Provoost V, Cools F, Bilsen J, Ramet J, Deconinc P, Stichele, RV, et al. The use of drugs with a life-shortening effect in end-of-life care in neonates and infants. Intensive Care Med 2006;32:133-9.
Griffin JP, Nelson JE, Koch KA, Niell HB, Ackerman TF, Thompson M, et al. End-of-life care in patients with lung cancer. Chest 2003;123;312S-31.
The CoBaTrICE collaboration. Development of core competencies for an international training programme in intensive care medicine. Intensive Care Med 2006;32:1371-83.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Med 2008;34:17-60.
Cook D, Rocker G, Heyland D. Dying in the ICU: Strategies that may improve end-of-life care. Can J Anesth 2004;51:266-72.
Carlet J, Thijs LG, Antonelli M, Cassell J, Cox P, Hill N, et al. Challenges in end-of-life care in the ICU: Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Medicine 2004;30:770-84.
Rubenfeld GD, Curtis JR; for the End-of-Life Care in the ICU Working Group. End-of-life care in the intensive care unit: A research agenda. Crit Care Med 2001;29:2001-6.
Mularski RA, Curtis JR, Billings JA, Burt R, Byock I, Fuhrman C, et al. Proposed quality measures for palliative care in the critically ill: A consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med 2006;34(Suppl):S404-11.
Curtis JR, Patrick DL, Engelberg RA, Norris K, Asp C, Byock I. A measure of the quality of dying and death: Initial validation using after-death interviews with family members. J Pain Symptom Manage 2002;24:17-31.
Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008;36:953-63.
Sprung CL, Woodcock T, Sjokvist P, Ricou B, Bulow HH, Lippert A, et al. Reasons, considerations, difficulties and documentation of endof- life decisions in European intensive care units: The Ethicus Study. Intensive Care Med 2008;34:271-7.
Mani RK. End of life care in India. Intensive Care Med 2006;32:1066-8.
Barnett VT, Aurora VK. Physician beliefs and practices regarding end of life care in India. Indian J Crit Care Med 2008;12:109-15.
Economist Intelligence Unit. Commissioned by LIEN Foundation. The quality of death: ranking end of life care across the world. Available from www.eiu.com/sponsor/lienfoundation/qualityofdeath [Last accessed on 2010].
Maceden S. Moving towards a National policy on Palliative and end of care. Indian J Palliat Care 2011;suppl;s42-44
Jayaram R, Ramakrishnan N. Cost of critical care in India. Indian J Crit Care Med 2008;12:55-61.
Firth S. End of life: A Hindu view. Lancet 2005;366:682-6.
Bülow HH, Sprung CL, Reinhart K, Prayag S, Du B, Armaganidis A, et al. The world's major religions’ points of view on end-of-life decisions in the intensive care unit. Intensive Care Med 2008;34:423-30.
Mani RK. Limitation of life support in the ICU. Indian J Crit Care Med 2003;7:112-7.
Beuks BC, Nijhof AC, Meertens JH, Ligtenberg JJ, Tulleken JE, Zijlstra JG. A good death. Intensive Care Med 2006;32:752-3.
Kallel H, Dammak H, Bahloul M, Ben Hamida C, Chelly H, Rekik N, et al. A good death: Another break in the wall. Intensive Care Med 2006;32:1915-6.
Boussarsar M, Bouchoucha S. Dying at home: Cultural and religious preferences. Intensive Care Med 2006;32:1917-8.
Puri VK. End of life care issues for modern India-lessons learnt in the West. Indian J Crit Care Med 2005;9:81-5.
Rajagopalan RE. End of life care. Indian J Crit Care Med 2005;9:75-6.
Mani RK, Mandal AK, Bal S, Javeri Y, Kumar R, Nama DK, et al. End-of-life decisions in an Indian intensive care unit. Intensive Care Med 2009;35:1713-9.
Kapadia F, Singh M, Divatia J, Vaidyanathan P, Udwadia FE, Raisinghaney SJ, et al. Limitation and withdrawal of intensive therapy at end of life: Practices in intensive care units in Mumbai, India. Crit Care Med 2005;33:1272-5.
Jog SA, Rajhans PA, Akole PV, Gadgil SJ, Pawar B, Gogate N, et al. “End of life” practice in India–family decision. Intensive Care Med 2007;S77 (abstr.)
Mani RK, Mandal AK, Bal S, Khan BJ, Kumar R, Nama D, et al. Outcome of critically ill elderly patients in medical ICU. Intensive Care Med 2007;S157 (abstr.)
Myatra SN, Divatia JV, Tandekar S, Khanvilkar V. Audit of end of life practices in an Indian Cancer hospital. World Congress in critical care 2009 (Abstr)
Yaguchi A, Truog RD, Curtis JR, Luce JM, Levy MM, Mélot C, et al. International differences in end-of-life attitudes in the intensive care unit. Arch Intern Med 2005;165:1970-5.
Frost DW, Cook DJ, Heyland DK, Fowler RA. International Differences in End-of-Life Attitudes in the Intensive Care Unit: Results of a Survey. Crit Care Med 2011;39:1174-89.
Balakrishnan S, Mani RK. Constitutional and legal provisions in Indian law for limiting life support. Indian J Crit Care Med 2005;9:108-14.
Aruna Ramachandra Shanbaug vs The Union of India & Ors. WRIT PETITION(CRIMINAL) NO. 115 OF 2009(Supreme Court of India Proceedings).
Luce JM, Alpers A. Legal aspects of withholding and withdrawing life support from critically ill patients in the United States and providing palliative care to them. Am J Respir Crit Care Med 2000;162:2029-32.
Luce JM, Lemaire F. Two transatlantic viewpoints on an ethical quandary. Am J Respir Crit Care Med 2001;163:818-21.
Emanuel JE, Emanuel LL. Palliative and end of life care. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Janson JL, editors. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Co; 2005. p. 53-66.
Law Commission of India. 196th report. Medical treatment of terminally ill patients (for the protection of patients and Medical practitioners). Available from: http://lawcommissionofindia.nic.in/reports/rep196.pdf [Last accessed on 2006].
Mani RK. The Aruna Shanbaug case- a step forward, not a giant leap. Times of India, The crest edition. March 12, 2011, p. 8.
Kuiper MA, Whetstine LM, Holmes JL, Streat S, Burrows RC, Seppelt I, et al. Euthanasia: A word no longer to be used or abused. Intensive Care Med 2007;33:549-50.
Michalsen A, Reinhart K. “Euthanasia”: A confusing term, abused under the Nazi regime and misused in present end-of-life debate. Intensive Care Med 2006;32:1304-10.
Quill TE, Dresser R, Brock DW. The role of double effect- a critique of its role in decision-making. N Engl J Med 1997;337:1768-71.
American Academy Of Physician Assistants (policy adopted by AAPA). End of life decision making. http://www.aapa.org/gandp/eol.html [Last accessed on 2004].
Levy MM. Shared decision-making in the ICU: Entering a new era. Crit Care Med 2004;32:1966-8.
Christakis NA, Asch DA. Physician characteristics associated with decisions to withdraw life support. Am J Public Health 1995;85:367-72.
Marik PE, Varon J, Lisbon A, Reich HS. Physicians' own preferences to the limitation and withdrawal of life-sustaining therapy. Resuscitation 1999:42:197-201.
Levin PD, Sprung CL. Cultural differences at the end of life. Crit Care Med 2003;31:S354-7.
Rocker G, Cook D, Sjokvist P, Weaver B, Finfer S, McDonald E, et al. Clinician predictions of intensive care unit mortality. Crit Care Med 2004;32:1149-54.
Keenan SP, Busche KD, Chen LM, McCarthy L, Inman KJ, Sibbald WJ. A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support. Crit Care Med 1997;25:1324-31.
Luce JM. Making decisions about the forgoing of life-sustaining therapy. Am J Respir Crit Care Med 1997;156:1715-8.
Marcin JP, Pollack MM, Patel KM, Ruttimann UE. Combining physician's subjective and physiology based objective mortality risk predictions. Crit Care Med 2000;28:2984-90.
American Thoracic Society. Withholding and withdrawing lifesustaining therapy. Ann Intern Med 1991;115:478-85.
Sinuff T, Cook DJ, Rocker GM, Griffith LE, Walter SD, Fisher MM, et al. For the level of care study investigators & the Canadian Critical Care Trials group. DNR directives are established early in mechanically ventilated intensive care patients. Can J Anaesth 2004;51:1034-41.
Le Conte P, Baron D, Trewick D, Touze MD, Longo C, Vial I, et al. Witholding and withdrawing life support therapy in an emergency department: prospective survey. Intensive Care Med 2004;30:2216-21.
Cook D, Rocker G, Marshall J, Sjokvist P, Dodek P, Griffith L, et al. for the level of care study investigators and the Canadian Critical Care Trials group. Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med 2003;349:1123-32.
Hall RL, Rocker GM, Murray D. Simple changes can improve conduct of end-of-life care in the intensive care unit. Can J Anesth 2004;51:631-6.
Holloway RG, Quill TE. Treatment Decisions after Brain Injury – Tensions among Quality, Preference, and Cost. N Engl J Med 2010;362:1757-9.
Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Bbttiger BW, et al. Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation 2008;79:350-79.
Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S; Quality Standards Subcommittee of the American Academy of Neurology. Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006;67;203-10.
Geocadin RG, Buitrago MM, Torbey MT, Chandra-Strobos N, Williams MA, Kaplan PW. Neuoogic prognosis and withdrawal of life support after resuscitation from cardiac arrest. Neurology 2006;67:105-8.
Goh AY, Lumm LC, Chan PW, Bakar F, Chong BO. Withdrawal of life support in Pediatric intensive care. Arch Dis Child 1999;80:424-8.
Devictor DJ, Nguyen DT, and the Groupe Francophone de Réanimation et d'Urgences Pédiatriques. Forgoing life-sustaining treatments: How the decision is made in Crit Care Med 2001; 29:1356-1359
Royal College of Pediatrics and Child Health. Withholding or withdrawing life saving treatment in children. A framework for practice. London: RCPCH; 1997.
Emanuel EJ, Emanuel L. Four models of physician-patient relationship. JAMA 1992;267:2221-6.
Gian Kaur Vs State of Punjab. AIR, Supreme Court 1996;83:1257-65.
Azoulay E, Pochard F, Chevret S, Lemaire F, Mokhtari M, Le Gall JR, et al. Meeting the needs of Intensive Care Unit patient families. Am J Respir Crit Care Med 2001;163:135-9.
Molter NC. Needs of relatives of critically ill patients. Heart Lung 1979;8:332-9.
Johnson D, Wilson M, Cavanaugh B, Bryden C, Gudmundson D, Moodley O. Measuring the ability to meet family needs in an intensive care unit. Crit Care Med 1998;26:266-71.
Hickey M. What are the needs of families of critically ill patients? A review of the literature since 1976. Heart Lung 1990;19:401-15.
Foss KR, Tenholder MF. Expectations and needs of persons with family members in an ICU as opposed to a general ward. South Med J 1993;86:380-4.
Price DM, Forrester DA, Murphy PA, Monaghan JF. Critical Care family needs in an urban teaching medical center. Heart Lung 1991;20:183-8.
Azoulay E, Sprung C. Family-physician interactions in the intensive care unit. Crit Care Med 2004;32:2323-8.
Studdert DM, Mello MM, Burns JP, Puopolo AL, Galper BZ, Truog RD, et al. Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors. Intensive Care Med 2003;29:1489-97.
Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinová K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: The conflicus study. Am J Respir Crit Care Med 2009;180:853-60.
McDonagh JR, Elliott TB, Engelberg RA, Treece PD, Shannon SE, Rubenfeld GD, et al. Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction. Crit Care Med 2004;32:1484-8.
Mani RK, Banga A, Verma A, Bal S, Sircar M, Pande R, et al. A multicenter study to evaluate the needs of families of critically ill patients from North India. Crit Care Med 2007;35:12.
Lautrette A, Ciroldi M, Ksibi H, Azoulay E. End-of-life family conferences: Rooted in the evidence. Crit Care Med 2006;34[Suppl.]:S364-72.
Curtis JR, Engelberg RA, Wenrich MD, Shannon SE, Treece PD, Rubenfeld GD. Missed opportunities during family conferences about end-of-life care in the intensive care unit. Am J Respir Crit Care Med 2005;171:844-9.
Luce JM. Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists. Crit Care Med 1995;23:760-6.
Seckler AB, Meiner DE, Mulvihill M, Paris BE. Substituted judgment: how accurate are proxy predictions? Ann Intern Med 1991;115:92-8.
Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, et al. Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Crit Care Med 2001;29:1893-7.
Azoulay E, Pochard F, Chevret S, Adrie C, Annane D, Bleichner G, et al. Half the family members of intensive care unit do not want to share in decision-making process: A study in 78 French intensive care units. Crit Care Med 2004;32:1832-8.
re Quinlan, 755 A2A 647 (H.J.), cert. Denied, 429 U.S. 922 (1976).
Barber v. Superior Court, 147 Cal. App.7d 1006 (Cal. App. 1983).
Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).
Airedale NHS Trust vs Bland:1993 (1)AII ER 821.
Mani RK, Rawat T, Basu R, Upadhyay S, Pathak S, Thakur L, et al. Impact of an “AND” (allow natural death) protocol on end of life decisions in an Indian ICU. Intensive Care Med 2011;S70 (Abstr.).
Quill A. Dying and decision making- the evolution of end of life options. N Engl J Med 2004;350:2029-32.
Ho LA, Engelberg RA, Curtis JR, Nelson J, Luce J, Ray DE, et al. Comparing clinician ratings of the quality of palliative care in the intensive care unit. Crit Care Med 2011;39:975-83.
Curtis JR, Engelberg RA. Measuring success of interventions to improve the quality of end-of-life care in the intensive care unit. Crit Care Med 2006;34[Suppl]:S341-7.
Slutsky AS, Hudson LD. Care of the unresponsive patient. N Engl J Med 2009;360:527-31.
Marco CA, Larkin G, Maskop J, Derse A. determination of futility in emergency medicine. Ann Emerg Med 2000;35:604-12.