Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report

Overview

Journal Indian J Crit Care Med

Specialty Critical Care

Date 2018 May 11

PMID 29743764

Citations 11

Authors

Naveen Salins

Roop Gursahani

Roli Mathur

Shivakumar Iyer

Stanley Macaden

Nagesh Simha

Raj Kumar Mani

M R Rajagopal

Affiliations

Soon will be listed here.

Abstract

Background: Indian hospitals, in general, lack policies on the limitation of inappropriate life-sustaining interventions at the end of life. To facilitate discussion, preparation of guidelines and framing of laws, terminologies relating to the treatment limitation, and providing palliative care at the end-of-life care (EOLC) need to be defined and brought up to date.

Methodology: This consensus document on terminologies and definitions of terminologies was prepared under the aegis of the Indian Council of Medical Research. The consensus statement was created using Nominal Group and Delphi Method.

Results: Twenty-five definitions related to the limitations of treatment and providing palliative care at the end of life were created by reviewing existing international documents and suitably modifying it to the Indian sociocultural context by achieving national consensus. Twenty-five terminologies defined within the scope of this document are (1) terminal illness, (2) actively dying, (3) life-sustaining treatment, (4) potentially inappropriate treatment, (5) cardiopulmonary resuscitation (CPR), (6) do not attempt CPR, (7) withholding life-sustaining treatment, (8) withdrawing life-sustaining treatment, (9) euthanasia (10) active shortening of the dying process, (11) physician-assisted suicide, (12) palliative care, (13) EOLC, (14) palliative sedation, (15) double effect, (16) death, (17) best interests, (18) health-care decision-making capacity, (19) shared decision-making, (20) advance directives, (21) surrogates, (22) autonomy, (23) beneficence, (24) nonmaleficence, and (25) justice.

Citing Articles

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Narayanan D, Chandrasekaran A, S E, Vyas N BMC Palliat Care. 2025; 24(1):62.

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Prognostic factors and development of the practical prediction score for 7-day mortality of palliative patients in the emergency department.

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Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit.

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Who Cares About Me? The Need of the Hour is to Improve Awareness and Quality of End-of-life Care Practices in Indian Intensive Care Units.

Singh U, Maurya I, Gurjar M Indian J Crit Care Med. 2023; 27(8):523-525.

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References

Horton J . Nominal group technique. A method of decision-making by committee. Anaesthesia. 1980; 35(8):811-4. DOI: 10.1111/j.1365-2044.1980.tb03924.x. View

Sidhu N, Dunkley M, Egan M . "Not-for-resuscitation" orders in Australian public hospitals: policies, standardised order forms and patient information leaflets. Med J Aust. 2007; 186(2):72-5. DOI: 10.5694/j.1326-5377.2007.tb00804.x. View

Shroff S . Legal and ethical aspects of organ donation and transplantation. Indian J Urol. 2009; 25(3):348-55. PMC: 2779960. DOI: 10.4103/0970-1591.56203. View

Doyal L . The moral character of clinicians or the best interests of patients?. BMJ. 1999; 318(7196):1432-3. PMC: 1115823. DOI: 10.1136/bmj.318.7196.1432. View

Cook D, Rocker G, Heyland D . Dying in the ICU: strategies that may improve end-of-life care. Can J Anaesth. 2004; 51(3):266-72. DOI: 10.1007/BF03019109. View

Daniels N . Justice, health, and healthcare. Am J Bioeth. 2002; 1(2):2-16. DOI: 10.1162/152651601300168834. View

Steinhauser K, Clipp E, McNeilly M, Christakis N, McIntyre L, Tulsky J . In search of a good death: observations of patients, families, and providers. Ann Intern Med. 2000; 132(10):825-32. DOI: 10.7326/0003-4819-132-10-200005160-00011. View

Gillon R . "Primum non nocere" and the principle of non-maleficence. Br Med J (Clin Res Ed). 1985; 291(6488):130-1. PMC: 1416256. DOI: 10.1136/bmj.291.6488.130. View

Cremer R, Hubert P, Grandbastien B, Moutel G, Leclerc F . Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in francophone PICUs. Intensive Care Med. 2011; 37(10):1648-55. PMC: 5663736. DOI: 10.1007/s00134-011-2320-3. View

10.

Wijdicks E . The diagnosis of brain death. N Engl J Med. 2001; 344(16):1215-21. DOI: 10.1056/NEJM200104193441606. View

11.

Rousseau P . Existential suffering and palliative sedation: a brief commentary with a proposal for clinical guidelines. Am J Hosp Palliat Care. 2001; 18(3):151-3. DOI: 10.1177/104990910101800303. View

12.

Sulmasy D, Lynn J . End-of-life care. JAMA. 1997; 277(23):1854-5. View

13.

Ferrand E, Robert R, Ingrand P, Lemaire F . Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group. Lancet. 2001; 357(9249):9-14. DOI: 10.1016/s0140-6736(00)03564-9. View

14.

Quill T, Dresser R, Brock D . The rule of double effect--a critique of its role in end-of-life decision making. N Engl J Med. 1997; 337(24):1768-71. DOI: 10.1056/NEJM199712113372413. View

15.

Snyder L, Sulmasy D . Physician-assisted suicide. Ann Intern Med. 2001; 135(3):209-16. DOI: 10.7326/0003-4819-135-3-200108070-00015. View

16.

Prendergast T, Claessens M, Luce J . A national survey of end-of-life care for critically ill patients. Am J Respir Crit Care Med. 1998; 158(4):1163-7. DOI: 10.1164/ajrccm.158.4.9801108. View

17.

Mani R, Mandal A, Bal S, Javeri Y, Kumar R, Nama D . End-of-life decisions in an Indian intensive care unit. Intensive Care Med. 2009; 35(10):1713-9. DOI: 10.1007/s00134-009-1561-x. View

18.

Bosslet G, Kesecioglu J, White D . How should clinicians respond to requests for potentially inappropriate treatment?. Intensive Care Med. 2016; 42(3):422-425. DOI: 10.1007/s00134-015-4192-4. View

19.

Teno J, Gruneir A, Schwartz Z, Nanda A, Wetle T . Association between advance directives and quality of end-of-life care: a national study. J Am Geriatr Soc. 2007; 55(2):189-94. DOI: 10.1111/j.1532-5415.2007.01045.x. View

20.

Jacobs I, Nadkarni V, Bahr J, Berg R, Billi J, Bossaert L . Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on.... Resuscitation. 2004; 63(3):233-49. DOI: 10.1016/j.resuscitation.2004.09.008. View