Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 18 , ISSUE 9 ( September, 2014 ) > List of Articles

GUIDELINES

End-of-life care policy: An integrated care plan for the dying

Jigeeshu V. Divatia, Stanley C. Macaden, Maryann Muckaden

Keywords : Care of the dying, end-of-life care in India, medical futility, position statement, terminal care, withholding and withdrawing

Citation Information : Divatia JV, Macaden SC, Muckaden M. End-of-life care policy: An integrated care plan for the dying. Indian J Crit Care Med 2014; 18 (9):615-635.

DOI: 10.4103/0972-5229.140155

License: CC BY-ND 3.0

Published Online: 01-03-2008

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Purpose: The purpose was to develop an end-of-life care (EOLC) policy for patients who are dying with an advanced life limiting illness and to develop practical procedural guidelines for limiting inappropriate therapeutic medical interventions and improve the quality of care of the dying within an ethical framework and through a professional and family/patient consensus process. Evidence: The Indian Society of Critical Care Medicine (ISCCM) published its first guidelines on EOLC in 2005 [1] which was later revised in 2012. [2] Since these publications, there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed observational studies, surveys, randomized controlled studies, as well as guidelines and recommendations, for education and quality improvement published across the world. The search terms were: EOLC; do not resuscitate directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; EOLC in India; cultural variations. Indian Association of Palliative Care (IAPC) also recently published its consensus position statement on EOLC policy for the dying. [3] Method: An expert committee of members of the ISCCM and IAPC was formed to make a joint EOLC policy for the dying patients. Proposals from the chair were discussed, debated, and recommendations were formulated through a consensus process. The members extensively reviewed national and international established ethical principles and current procedural practices. This joint EOLC policy has incorporated the sociocultural, ethical, and legal perspectives, while taking into account the needs and situation unique to India.

PDF Share
  1. Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P. Limiting life-prolonging interventions and providing palliative care towards the end of life in Indian intensive care units.  Ind J Crit Care Med 2005;9:96-107.
  2. Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P, et al. Guidelines for end of life and palliative care in Indian intensive care units:ISCCM consensus Ethical Position Statement. Indian J Crit Care Med 2012;16:166-81.
  3. Macaden SC, Salins N, Muckaden M, Kulkarni P, Joad A, Nirabhawane V, et al. End of life care policy for the dying: Consensus position statement of Indian Association of Palliative Care.  Ind J palliat Care 2014;20:171-81.
  4. Jayaram R, Ramakrishnan N. Cost of intensive care in India. Indian J Crit Care Med 2008;12:55-61.
  5. Mani RK. Limitation of life support in the ICU. Indian J Crit Care Med 2003;7:112-7.
  6. 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.
  7. Kapadia F, Singh M, Divatia J, Vaidyanathan P, Udwadia FE, Raisinghaney SJ, et al. Limitation and withdrawal of intensive therapy at the end of life: Practices in intensive care units in Mumbai, India. Crit Care Med 2005;33:1272-5.
  8. Barnett VT, Aurora VK. Physician beliefs and practice regarding end-of-life care in India. Indian J Crit Care Med 2008;12:109-15.
  9. Aruna Ramakrishna Shanbaugh. 2011 4 SCC 454 & 524. Also:AIR 2011 SC 1290.
  10. Murray S, Line D, Morris A. The quality of death ranking end of life care across the world. Report of Economic Intelligence Unit, Lein Foundation; 2010. Available from: http://www.eiu.com/sponsor/lienfoundation/qualityofdeath. [Last Accessed on 2014 July 30].
  11. Macaden SC. Moving toward a national policy on palliative and end of life care. Indian J Palliat Care 2011;17:S42-4.
  12. Heyland DK, Dodek P, Rocker G, Groll D, Gafni A, Pichora D, et al. What matters most in end-of-life care: Perceptions of seriously ill patients and their family members. CMAJ 2006;174:627-33.
  13. Smith R. Principles of a good death. Br Med J 2000;320:129-30.
  14. Steinhauser KE, Clipp EC, McNeilly M, Christakis NA, McIntyre LM, Tulsky JA. In search of a good death: Observations of patients, families, and providers. Ann Intern Med 2000;132:825-32.
  15. Sawkins N, Bawn R. The gold standards framework competency document. End Life Care 2010;4:58-9.
  16. Balakrishna S, Mani RK. Constitutional and legal provisions in Indian law for limiting life support. Indian J Crit Care Med 2005;9:108-14.
  17. Rathinam P Vs Union of India. Supreme Court India Proc 1994;3:394-430.
  18. Kaur G Vs State of Punjab. Supreme Court India Proc 1996;83:1257-65.
  19. Medical treatment of terminally ill patients (for the protection of patients and medical practitioners). 196 th Report of Law Commision of India; 2006. Available from: http://www.lawcommissionofindia.nic.in/reports/rep196.pdf. [Last Accessed on 2014 Aug 5].
  20. 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 5 th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med 2004;30:770-84.
  21. Passive Euthanasia-A Relook. 241 st Report of Law Commision of India; 2012. Available from: http://www.lawcommissionofindia.nic.in/reports/rep241.pdf. [Last Accessed on 2014 Aug 5].
  22. 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.
  23. Griffin JP, Koch KA, Nelson JE, Cooley ME, American College of Chest Physicians. Palliative care consultation, quality-of-life measurements, and bereavement for end-of-life care in patients with lung cancer: ACCP evidence-based clinical practice guidelines (2 nd edition). Chest 2007;132:404S-22.
  24. CoBaTrICE Collaboration, Bion JF, Barrett H. Development of core competencies for an international training programme in intensive care medicine. Intensive Care Med 2006;32:1371-83.
  25. 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 [corrected] of Critical Care Medicine. Crit Care Med 2008;36:953-63.
  26. Crippen DW, Kilcullen JK, Kelly DF, editors. Three Patients: International Perspective on Intensive Care at the End of Life. USA: Kluwer Academic Publishers, Mass. 2002.
  27. Cook D, Rocker G, Heyland D. Dying in the ICU: strategies that may improve end-of-life care. Can J Anaesth 2004;51:266-72.
  28. Quill TE, Dresser R, Brock DW. The rule of double effect - A critique of its role in end-of-life decision making. N Engl J Med 1997;337:1768-71.
  29. Halpern J. Empathy and patient-physician conflicts. J Gen Intern Med 2007;22:696-700.
  30. Back A, Arnold R, Tulsky J. Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope. 1 st ed. United Kingdom: Cambridge University Press; 2009.
  31. Friedrichsen MJ, Strang PM. Doctors′ strategies when breaking bad news to terminally ill patients. J Palliat Med 2003;6:565-74.
  32. Curtis JR, White DB. Practical guidance for evidence-based ICU family conferences. Chest 2008;134:835-43.
  33. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist 2000;5:302-11.
  34. Conflict resolution in end-of-life settings (CRELS). Final CRELS Project Working Group Report Including Consultation Summary. NSW Department of Health; 2010. [Last accessed: 2014 Aug 10]
  35. Guidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1999;27:633-8.
  36. Salins NS, Pai SG, Vidyasagar M, Sobhana M. Ethics and medico legal aspects of "not for resuscitation". Indian J Palliat Care 2010;16:66-9.
  37. National Care of the Dying Audit Hospitals. Executive Summay 2011/2012 Led by Marie Curie Palliative Care Institute Liverpool. Available from: http://www.mcpcil.org.uk/liverpool-care-pathway/national-care-of-dying-audit.htm. [Last Accessed on 2014 July 30].
  38. Ellershaw J, Ward C. Care of the dying patient: The last hours or days of life. BMJ 2003;326:30-4. [Last Accessed on 2014 July 30].
  39. More care, less pathway. A review of liverpool care pathway for the dying (independent report). Department of Health, UK, 2013. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf. [Last Accessed on 2014 Aug 1].
  40. The Liverpool Care Pathway. Scottish Government Website. Available from: http://www.scotland.gov.uk/Topics/Health/Quality-Improvement-Performance/Living-Dying-Well/Liverpool-Care-Pathwa. [Last Accessed on 2014 Aug 1].
  41. Kennedy C, Brooks-Young P, Brunton Gray C, Larkin P, Connolly M, Wilde-Larsson B, et al. Diagnosing dying: An integrative literature review. BMJ Support Palliat Care 2014;4:263-70.
  42. Whitmer M, Hurst S, Prins M, Shepard K, McVey D. Medical futility: A paradigm as old as Hippocrates. Dimens Crit Care Nurs 2009;28:67-71.
  43. Youngner SJ. Who defines futility? JAMA 1988;260:2094-5.
  44. Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: Its meaning and ethical implications. Ann Intern Med 1990;112:949-54.
  45. Brody BA, Halevy A. Is futility a futile concept? J Med Philos 1995;20:123-44.
  46. Grossman E, Angelos P. Futility: What Cool Hand Luke can teach the surgical community. World J Surg 2009;33:1338-40.
  47. Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med 1992 4;326:1560-4.
  48. Chwang E. Futility clarified. J Law Med Ethics 2009;37:487-95, 396.
  49. Bloomer MJ, Tiruvoipati R, Tsiripillis M, Botha JA. End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study. Aust Crit Care 2010;23:13-9.
  50. Seale C. Hastening death in end-of-life care: A survey of doctors. Soc Sci Med 2009;69:1659-66.
  51. Finley Caulfield A, Gabler L, Lansberg MG, Eyngorn I, Mlynash M, Buckwalter MS, et al. Outcome prediction in mechanically ventilated neurologic patients by junior neurointensivists. Neurology 2010;74:1096-101.
  52. Gabbay E, Calvo-Broce J, Meyer KB, Trikalinos TA, Cohen J, Kent DM. The empirical basis for determinations of medical futility. J Gen Intern Med 2010;25:1083-9.
  53. Jiang Z, Yang L, Guo P, Gong S. Medical futility in the era of evidence-based medicine. J Biomed Res 2014;28:249-50.
  54. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005;171:987-94.
  55. Heyland DK, Rocker GM, Dodek PM, Kutsogiannis DJ, Konopad E, Cook DJ, et al. Family satisfaction with care in the intensive care unit: Results of a multiple center study. Crit Care Med 2002;30:1413-8.
  56. Sinuff T, Giacomini M, Shaw R, Swinton M, Cook DJ, CARENET. "Living with dying": The evolution of family members′ experience of mechanical ventilation. Crit Care Med 2009;37:154-8.
  57. Simpson C. When hope makes us vulnerable: A discussion of patient-healthcare provider interactions in the context of hope. Bioethics 2004;18:428-47.
  58. 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.
  59. 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.
  60. Levy MM. Shared decision-making in the ICU: Entering a new era. Crit Care Med 2004;32:1966-8.
  61. Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment? BMJ 1999;319:780-2.
  62. Mani RK, Banga A, Verma A, Bal S, Sircar M, Pande R. A multicenter study to evaluate the needs of families of critically ill patients from North India. Crit Care Med 2007;35:12.[(Suppl) Abstr.].
  63. 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.
  64. Majesko A, Hong SY, Weissfeld L, White DB. Identifying family members who may struggle in the role of surrogate decision maker. Crit Care Med 2012;40:2281-6.
  65. Pochard F, Darmon M, Fassier T, Bollaert PE, Cheval C, Coloigner M, et al. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care 2005;20:90-6.
  66. Chan R, Webster J. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev 2010:CD008006.
  67. Pantilat SZ, Isaac M. End-of-life care for the hospitalized patient. Med Clin North Am 2008;92:349-70, viii.
  68. Wilkie DJ, Ezenwa MO. Pain and symptom management in palliative care and at end of life. Nurs Outlook 2012;60:357-64.
  69. Walling AM, Brown-Saltzman K, Barry T, Quan RJ, Wenger NS. Assessment of implementation of an order protocol for end-of-life symptom management. J Palliat Med 2008;11:857-65.
  70. Olausson J, Ferrell BR. Care of the body after death. Clin J Oncol Nurs 2013;17:647-51.
  71. Forte AL, Hill M, Pazder R, Feudtner C. Bereavement care interventions: a systematic review. BMC Palliat Care 2004;3:3.
  72. Temkin-Greener H, Zheng NT, Norton SA, Quill T, Ladwig S, Veazie P. Measuring end-of-life care processes in nursing homes. Gerontologist 2009;49:803-15.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.