The Ministry of Health and Family Welfare (MOHFW) has issued new guidelines for healthcare providers on withdrawing or withholding life support in terminally ill patients. These guidelines will be available in the public domain for public comments for a period of 1 month.
The guidelines emphasize respect for patient autonomy and the right to refuse life-sustaining treatment (LST) even if it leads to death. Decisions should prioritize the patient’s best interests, considering potential benefits and harms.
Conditions for Withdrawing/Withholding LST:
- The patient has a terminal illness with no hope of recovery.
- LST is unlikely to benefit the patient and may cause unnecessary suffering.
- In cases where the patient lacks decision-making capacity, a surrogate can make choices based on documented patient wishes or their own understanding of the patient’s best interests.
The guidelines highlight core principles such as beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm), and distributive justice (fair allocation of medical resources).
The guidelines stress on open and honest communication with patients and families. This ensures that they are fully informed about treatment options, prognoses, and consequences of decisions. Detailed documentation of all discussions and decisions is mandatory.
The guidelines adhere to Supreme Court rulings that uphold the right to refuse LST and outline legal requirements for decision-making processes when patients lack capacity. Active euthanasia remains illegal.
Medical Board Composition and Roles
- Primary Medical Board (PMB): Formed by the hospital for each case, consisting of the primary physician and at least two subject-matter experts.
- Secondary Medical Board (SMB): Established by the hospital with one member nominated by the Chief Medical Officer (CMO) and at least two subject-matter experts. The SMB reviews and validates the PMB’s recommendations.
Hospitals are encouraged to establish Clinical Ethics Committees with multi-disciplinary members to provide oversight, conflict resolution, and ongoing review of these practices.
