DrBhavani Chandrasekharan
New member
DIGNIFIED DEATH
………………………
Patients who have an irreversible medical problem that is totally incompatible with a fairly normal life, are seen to be admitted in the Intensive Care Units and almost invariably connected to a Ventilator to assist in proper breathing so that all the organs are (falsely) rejuvenated.If the heart stops beating ,again a cardiac massage is tried to revive him/her, don’t know for what.And he/she is declared dead after a few days.
Doctors or the patient’s relatives are never to be blamed.A doctor has to try his level best to save his patient but should have the presence of mind to talk to the bystanders about the true state of affairs .Patient’s people too should not compel doctors to proceed with futile attempts at any cost.Communication between the doctor and the patient’s relatives has to be effective enough to prevent unnecessary prolonged and expensive treatment with poor outcome.Relatives may feel less burdened by guilt if Physicians strongly recommend that life support is futile and it can be withdrawn, rather than asking the family to make the decision.
In various intensive care units around 10% patients are put on advanced life support despite there being no chance of them benefiting from the treatment.
I lost my husband, though at his ripe age of 81, very recently.He was a chronic cardiac patient who had undergone a number of risky surgeries .After a surgery for Aneurysm of the Aorta in 2011 he was given a lifetime of just 5 more years but as he followed a strict lifestyle with all health checkups and advices he could make it well for another 6 years.He died of a urinary infection which did not respond to any antibiotics under the sky.He had to be on various antibiotics for long term in his childhood and after his surgeries.As a result his urinary bacteria became resistant to antibiotics.
He had multi-organ failure and was put on ventilator support.His reports were all bad and I , backed by my family,(the patient ie my husband,myself,son and d in law are doctors),requested the doctors to withdraw his life supports.They were hesitant and and were very sincerely around to find ways to save their ex colleague‘s husband. 2 more days passed and they obeyed our request.I would have got him back home, a very rare chance, after a few weeks or months of intensive treatment, in a vegetative state.As septuagenarians I and husband used to discuss about death and both of us were adamant that unnecessary life supports should not prolong our lives.
My 96 yr old Amma called me one late evening,‘you reach here today’.It was just 2 hours drive but I had patients waiting and had a busy surgery schedule the next day.My mom said, in her usual way,‘Are you the only Gynaecologist there?’..On reaching I found that she had a chest pain and was refusing to go to hospital. She had a similar event a few months back.She said,‘they will put me in the ICU and revive me.I have lived my life fully’.After assuring her that she wouldn’t be admitted to the ICU we took her to the hospital.She was given medicines to alleviate the severe pain.She had a peaceful death after a few hours.All of us were around her.
For at least three patients in my town during the Covid pandemic, I had to be instrumental in convincing the bystanders about the need for removing the life supports of their dear ones in the ICUs.
Mrs X, a lady well acquainted with me, suffering from a stage 4 cancer was in the ICU for 2 weeks.When doctors tried to explain facts the bystanders were not convinced and took her to another hospital.There too she had to be in the ICU.The husband and sons of that middle class family were spending lakhs in a futile attempt to save her.They said they expected her to survive.It was a heavy task to convince them and make her free.
The “End of Life Care” policy has been developed by a team of experts at the All India Institute of Medical Sciences (AIIMS).The policy is aimed at providing the option of a dignified death to patients in cases where treatment will not extend their life or its quality. However, it is still a draft yet to be implemented .Several people for whom further treatment is futile are still hooked on to tubes and ventilators instead of being home with their families.
The guidelines allow for withholding or withdrawal of care in patients who are severely dependent on life support, are very old, have multiple co-morbidities, have multiple organ failure, worsening vital signs, are likely to have poor neurological outcome after a cardiac arrest, and also those who are brain dead.
The treating doctor has to decide whether further treatment in a patient is futile, with two other consultants from the same department not directly involved in the treatment of the patient seconding this. Then the family members have to be informed. Communication should include explanation on the terminal nature of illness, short life expectancy, burden versus benefit of aggressive further management, and symptoms expected in last few days or hours and how to manage.
If the patient is competent, the decision must be taken as per his/ her wishes. But by the time they reach this stage, they might have lost the capacity to exercise the judgement.Even if treatment is futile, doctors will not abandon the patients. The aim is to ensure that the patient remains comfortable and pain-free till the end. A palliative care referral will be done for such patients.Such care centres are already receiving many terminally ill patients who scare to go home.
The treatments will be withheld or withdrawn only if the patient or the family members agree.
The AIIMS guidelines go a step ahead of the “Do not attempt Resuscitation” guidelines developed by India’s apex medical research body, the Indian Council of Medical Research (ICMR), which allows physicians to not attempt cardio-pulmonary resuscitation (CPR) in patients with incurable diseases. It, however, does not allow the withholding or withdrawal of active care.
It is high time Euthanasia ( Mercy Killing) is legalised here.
………………………
Patients who have an irreversible medical problem that is totally incompatible with a fairly normal life, are seen to be admitted in the Intensive Care Units and almost invariably connected to a Ventilator to assist in proper breathing so that all the organs are (falsely) rejuvenated.If the heart stops beating ,again a cardiac massage is tried to revive him/her, don’t know for what.And he/she is declared dead after a few days.
Doctors or the patient’s relatives are never to be blamed.A doctor has to try his level best to save his patient but should have the presence of mind to talk to the bystanders about the true state of affairs .Patient’s people too should not compel doctors to proceed with futile attempts at any cost.Communication between the doctor and the patient’s relatives has to be effective enough to prevent unnecessary prolonged and expensive treatment with poor outcome.Relatives may feel less burdened by guilt if Physicians strongly recommend that life support is futile and it can be withdrawn, rather than asking the family to make the decision.
In various intensive care units around 10% patients are put on advanced life support despite there being no chance of them benefiting from the treatment.
I lost my husband, though at his ripe age of 81, very recently.He was a chronic cardiac patient who had undergone a number of risky surgeries .After a surgery for Aneurysm of the Aorta in 2011 he was given a lifetime of just 5 more years but as he followed a strict lifestyle with all health checkups and advices he could make it well for another 6 years.He died of a urinary infection which did not respond to any antibiotics under the sky.He had to be on various antibiotics for long term in his childhood and after his surgeries.As a result his urinary bacteria became resistant to antibiotics.
He had multi-organ failure and was put on ventilator support.His reports were all bad and I , backed by my family,(the patient ie my husband,myself,son and d in law are doctors),requested the doctors to withdraw his life supports.They were hesitant and and were very sincerely around to find ways to save their ex colleague‘s husband. 2 more days passed and they obeyed our request.I would have got him back home, a very rare chance, after a few weeks or months of intensive treatment, in a vegetative state.As septuagenarians I and husband used to discuss about death and both of us were adamant that unnecessary life supports should not prolong our lives.
My 96 yr old Amma called me one late evening,‘you reach here today’.It was just 2 hours drive but I had patients waiting and had a busy surgery schedule the next day.My mom said, in her usual way,‘Are you the only Gynaecologist there?’..On reaching I found that she had a chest pain and was refusing to go to hospital. She had a similar event a few months back.She said,‘they will put me in the ICU and revive me.I have lived my life fully’.After assuring her that she wouldn’t be admitted to the ICU we took her to the hospital.She was given medicines to alleviate the severe pain.She had a peaceful death after a few hours.All of us were around her.
For at least three patients in my town during the Covid pandemic, I had to be instrumental in convincing the bystanders about the need for removing the life supports of their dear ones in the ICUs.
Mrs X, a lady well acquainted with me, suffering from a stage 4 cancer was in the ICU for 2 weeks.When doctors tried to explain facts the bystanders were not convinced and took her to another hospital.There too she had to be in the ICU.The husband and sons of that middle class family were spending lakhs in a futile attempt to save her.They said they expected her to survive.It was a heavy task to convince them and make her free.
The “End of Life Care” policy has been developed by a team of experts at the All India Institute of Medical Sciences (AIIMS).The policy is aimed at providing the option of a dignified death to patients in cases where treatment will not extend their life or its quality. However, it is still a draft yet to be implemented .Several people for whom further treatment is futile are still hooked on to tubes and ventilators instead of being home with their families.
The guidelines allow for withholding or withdrawal of care in patients who are severely dependent on life support, are very old, have multiple co-morbidities, have multiple organ failure, worsening vital signs, are likely to have poor neurological outcome after a cardiac arrest, and also those who are brain dead.
The treating doctor has to decide whether further treatment in a patient is futile, with two other consultants from the same department not directly involved in the treatment of the patient seconding this. Then the family members have to be informed. Communication should include explanation on the terminal nature of illness, short life expectancy, burden versus benefit of aggressive further management, and symptoms expected in last few days or hours and how to manage.
If the patient is competent, the decision must be taken as per his/ her wishes. But by the time they reach this stage, they might have lost the capacity to exercise the judgement.Even if treatment is futile, doctors will not abandon the patients. The aim is to ensure that the patient remains comfortable and pain-free till the end. A palliative care referral will be done for such patients.Such care centres are already receiving many terminally ill patients who scare to go home.
The treatments will be withheld or withdrawn only if the patient or the family members agree.
The AIIMS guidelines go a step ahead of the “Do not attempt Resuscitation” guidelines developed by India’s apex medical research body, the Indian Council of Medical Research (ICMR), which allows physicians to not attempt cardio-pulmonary resuscitation (CPR) in patients with incurable diseases. It, however, does not allow the withholding or withdrawal of active care.
It is high time Euthanasia ( Mercy Killing) is legalised here.
