Coma dilemma: White paper soon on ventilator plug
Should a terminally ill patient be put on ventilator? How long should doctors and caregivers continue to treat a patient in coma? These questions that haunt doctors and attendants may soon be addressed by the Central government’s decision to bring out a white paper on Do Not Resuscitate (DNR) – a concept that gives patients and kin the right to withhold or withdraw treatment like use of ventilator.

Indian Council of Medical Research (ICMR) is scheduled to release the white paper by December, said director-General ICMR Dr Balram Bhargava, who was in Lucknow on Saturday to address the annual conference of Association of Physicians of India.

“Doctors and family members are in perpetual dilemma when it comes to reviving an elderly or critically ill patient, who could be suffering from multiple chronic problems or syndrome with minimal chances to bounce back.

Medical law on this count is imprecise and decision-making for family members is a Catch-22 situation, which often aggravates due to social pressure. Many developed nations follow the ‘Do Not Resuscitate’ guidelines to address the issue. We are also working on similar lines,” said Dr Bhargava. DNR is about accepting natural death, says expert Speaking to reporters at the conference hosted by King George’s Medical University (KGMU), Dr Bhargava said a panel of experts and stakeholders, including critical-care physicians, cancer specialists, geriatric physicians, legal-eagles, community health, and public health experts are among others working on the DNR white paper.

Elaborating on the concept, KGMU’s Dr D Himanshu said: “This dilemma comes with a cost, which often burdens the healthcare system, particularly caregivers. In India, due to shortage of ventilators, patients in waiting list also suffer.” This is exemplified by the situation at KGMU, which has 260 ventilators with 100% occupancy and waiting list of 50 at any given point of time.

To a query on how DNR was different from euthanasia, Dr Himanshu said: “Unlike euthanasia where a patient is put to death, DNR is about accepting death naturally. In mercy killing, patient may be introduced to external agents to expedite painless death, but in DNR, patients are aware that death is inevitable and consciously avoid painful medical procedures or situations.”

City geriatrician Dr Abhishek Shukla, who often witnesses the dilemma, said: “The paper will pave way for a policy on DNR by bringing focus on how to live and die with respect and autonomy.”

Citing global data in his book ‘Health and Well Being in Late Life’, author Prasun Chatterjee noted over 90% of American ICU patients have the right to withhold or withdraw a medical treatment process. He pointed out that in UK, British Medical Association and the Resuscitation Council (UK) has a precise DNR procedure.

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