CPR, DNR, Physician-assisted suicide: ICMR definitions on End of Life Care, Details
ICMR released the definition of terms used in limitation of treatment and providing palliative care at end of life.
End-of-Life (EOL) care presents many challenges for clinicians as well as for patients and their families. The challenges faced by the terminally ill patients are substantial and potentially overwhelming; physical pain, depression and a variety of intense emotions, the loss of dignity,
hopelessness and apparently tiresome tasks that need to be addressed at the end of life. An understanding of the dying patient’s experience should help clinicians improve care for them.
A consensus document was prepared by ICMR in order to standardize, update and remove ambiguities in the definitions of terms relating to end of life care (EOLC). This is required to facilitate dialogue, data collection and research, towards informing the development of bioethics and law relating to these areas.
The definitions released by ICMR accordingly include:
1. Terminal illness: An irreversible or incurable disease condition from which death is expected in the foreseeable future.
2. Actively Dying: The hours or days preceding imminent death during which time the patient’s physiological functions wane.
3. Life-sustaining treatment: Life-sustaining treatment comprises of any medical treatment that artificially supports or replaces, a bodily function essential to the life of the person.
4. Potentially inappropriate treatment: It connotes interventions aimed at cure that carry far greater possibilities of harm than reasonable possibilities of benefit.
5. Cardiopulmonary Resuscitation (CPR): It is an emergency medical procedure that combines chest compression often with artificial ventilation.
6. Do not attempt Resuscitation (DNR): A decision not to initiate or perform CPR on the background of terminal illness in accordance with prior expressed wishes of the patient or surrogate.
7. Withholding of life-sustaining treatment: A decision made not to initiate or escalate a life-sustaining treatment in terminal illness in accordance with expressed wishes of the patient or surrogate.
8. Withdrawal of life-sustaining treatment: A decision made to cease or remove a life-sustaining intervention in terminal illness in accordance with expressed wishes of the patient or surrogate.
9. Euthanasia: Euthanasia is the intentional act of killing a terminally ill patient on voluntary request, by the direct intervention of a doctor for the purpose of the good of the patient.
10. Active shortening of life process: An active intentional act to hasten death or shorten the life of a dying patient with terminal illness.
11. Physician-assisted suicide: An intentional act by the physician, on voluntary request of a dying patient with terminal illness, providing the means or methods with which to help a person to end his/her life.
12. Palliative Care: Palliative care is a holistic approach to treatment that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering.
13. End of life care: An approach to a terminally ill patient that shifts the focus of care to symptom control, comfort, dignity, quality of life and quality of dying rather than treatments aimed at cure or prolongation of life.
14. Palliative sedation: Palliative sedation is the administration of sedative substances at the minimal dosages necessary intentionally to lower the consciousness level definitely or temporarily in a terminally ill patient.
15. Double Effect: A principle that distinguishes the effects that are intended, from those that are unintended but may be adverse though foreseeable.
16. Death: Irreversible cessation of the heart and circulatory function, or neurological function of the brain including the brain stem.
17. Best Interests: A concept that requires physicians to ensure potential benefits to outweigh harms before undertaking medical interventions.
18. Healthcare Decision making capacity: The capacity of a patient to make an independent, informed decision.
19. Shared decision making: A dynamic process with responsibility for decisions about the medical care of a patient being shared between the health care team and the patient or surrogates.
20. Advance Directives: A statement made by a person with decision-making capacity stating his/her wishes regarding how to be treated or not treated at a stage when s/he loses such capacity.
21. Surrogate: Surrogate is a person or persons other than the healthcare providers who is/are accepted as the representatives of the patient’s best interests, who will make decisions on behalf of the patient when the patient loses decision-making capacity.
22. Autonomy: It is the right of an individual to make a free and informed decision.
23. Beneficence: A principle that makes it obligatory on the part of physicians to act in the best interests of patients.
24. Non-maleficence: A principle that directs physicians to first of all not do harm.
25. Justice: In the context of medical care requires that all people be treated without prejudice and that healthcare resources be used equitably.
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