Constitutional and legal protection for life support limitation in India

Mani, RK

doi:10.4103/0973-1075.164903

Cited by 11 publications

(9 citation statements)

References 13 publications

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“…The practice of incorporating palliation and EOL care in the ICU has gained momentum in India. [ 8 9 10 11 12 13 ] Our research throws light on the attitude, beliefs, and knowledge of EOL and palliative care among critical care nurses in eastern India. The nurses belong to a wide spectrum of ICUs with a minimum critical care experience of 3 months.…”

Section: Discussionmentioning

confidence: 99%

Intensive care nurses\' attitude on palliative and end of life care

Tripathy

Routray

Mishra

2017

Indian Journal of Critical Care Medicine

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Background:Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation.Aim:This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL.Materials and Methods:A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs.Results:Of 178 questionnaires distributed, 138 completed, with a response rate of 75.5*. About half (48.5*) had more than 1 year ICU experience. A majority (81.9*) agreed that nurses should be involved in and initiate (62.3*) EOL discussions. Terms “EOL care or palliative care in ICU” were new for 19.6*; 21* and 55.8* disagreed with allowing peaceful death in terminal patients and unrestricted family visits, respectively. Work experience was associated with wanting unrestricted family visitation, discontinuing monitoring and investigations at EOL, equating withholding and withdrawal of treatment, and being a part of EOL team discussions (P = 0.005, 0.01, 0.01, and 0.001), respectively. Religiousness was associated with a greater desire to initiate EOL discussions (P = 0.001).Conclusion:Greater emphasis on palliative care in critical care curriculum may improve awareness among critical care nurses.

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Section: Discussionmentioning

confidence: 99%

Intensive care nurses\' attitude on palliative and end of life care

Tripathy

Routray

Mishra

2017

Indian Journal of Critical Care Medicine

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“…In India, at present, there is a lack of legal clarity on cardiopulmonary resuscitation and it may hinder the health-care providers from limiting life-sustaining treatment at end of life. Position paper[ 35 ] and guidelines[ 36 ] on end-of-life care and information on legal provisions available for limiting life-sustaining treatment in India[ 37 ] may empower the health-care providers in providing appropriate end-of-life care. This should be included as a part of the end-of-life care training.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of implementing the integrated care plan for the dying in the Indian setting: Survey of perspectives of indian palliative care providers

Salins

Johnson²,

Macaden

2017

Indian J Palliat Care

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Introduction:Capacity to provide end-of-life care in India is scored as 0.6/100, and very few people in India have access to palliative and end-of-life care. Lack of end-of-life care provision in India has led to a significant number of people receiving inappropriate medical treatment at the end of life, with no access to pain and symptom control and high treatment costs. The International Collaborative for the Best Care for the Dying Person is an initiative that offers the opportunity to apply international evidence on the key factors required to provide best care for the dying in the Indian context. The aim of this study is to ascertain the perceptions of Indian palliative care providers regarding the feasibility and acceptability of implementing the international program in the Indian setting.Methods:Thirty participants from 16 palliative care centers who had participated in the foundation course of the International Collaborative for Best Care for the Dying Person were purposively chosen for the study. All participants were asked to complete the survey questionnaire that had both open- and close-ended questions.Results:Twenty-three participants completed this survey. The majority of items in the international program were considered relevant, representative of end-of-life care and acceptable in Indian setting. However, participants felt that the concept of the multidisciplinary team (MDT) being responsible for recognizing death may not be possible in the existing Indian setting and a senior doctor may not always be available to document a MDT decision. Some participants felt that in the Indian setting, it was not always possible to communicate about the dying process and make patient aware of the same. A small number of participants felt that using leaflets for communicating end-of-life care process may not be always possible due to logistic reasons and cost. Six participants felt that giving the dying person the opportunity to discuss their wishes, feelings, faith, beliefs, and values may not be possible, representative, and not applicable in Indian setting. The majority of participants felt that using equipment such as a syringe driver for continuous infusion is relevant (n = 16) and representative (n = 13) of end-of-life care, however most thought that it could be challenging to apply in an Indian setting (n = 17), including concerns about lack of familiarity and knowledge and applicability in home care settings. Six participants had reservations regarding the limitation of life-sustaining treatment and felt that discussion and review of cardiopulmonary resuscitation should happen prior to patients entering their end-of-life phase. While most participants thought relevance, representation, and applicability of assessing skin integrity as important, a few participants felt this assessment challenging, especially in home setting, and recommended Braden scale to be used instead of Waterlow for assessing skin integrity. Most participants agreed on the importance of assisted hydration and nutrition; however, ag...

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“…Futile intensive care for the wealthy, or the practice of LAMA (Left Against Medical Advice) for the poor are the unfortunate choices due to the lack of the legal framework or policies for patient autonomy and good end-of-life care practices. [ 39 43 ] The huge socioeconomic divide contributes to health-care practices that are not uniform. [ 41 ]…”

Section: Iversity In H Ealth-care mentioning

confidence: 99%

Challenges of using methadone in the Indian pain and palliative care practice

Viswanath

Palat

Chary

et al. 2018

Indian J Palliat Care

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Palliative care providers across India lobbied to gain access to methadone for pain relief and this has finally been achieved. Palliative care activists will count on the numerous strengths for introducing methadone in India, including the various national and state government initiatives that have been introduced recognizing the importance of palliative care as a specialty in addition to improving opioid accessibility and training. Adding to the support are the Non-Governmental Organizations (NGOs), the medical fraternity and the international interactive and innovative programs such as the Project Extension for Community Health Outcome. As compelling as the need for methadone is, many challenges await. This article outlines the challenges of procuring methadone and also discusses the challenges specific to methadone. Balancing the availability and diversion in a setting of opioid phobia, implementing the amended laws to improve availability and accessibility in a country with diverse health-care practices are the major challenges in implementing methadone for relief of pain. The unique pharmacology of the drug requires meticulous patient selection, vigilant monitoring, and excellent communication and collaboration with a multidisciplinary team and caregivers. The psychological acceptance of the patient, the professional training of the team and the place where care is provided are also challenges which need to be overcome. These challenges could well be the catalyst for a more diligent and vigilant approach to opioid prescribing practices. Start low, go slow could well be the way forward with caregiver education to prescribe methadone safely in the Indian palliative care setting.

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Constitutional and legal protection for life support limitation in India

Cited by 11 publications

References 13 publications

Intensive care nurses\' attitude on palliative and end of life care

Intensive care nurses\' attitude on palliative and end of life care

Feasibility and acceptability of implementing the integrated care plan for the dying in the Indian setting: Survey of perspectives of indian palliative care providers

Challenges of using methadone in the Indian pain and palliative care practice

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