Doctors keeping patients in intensive care units to inflate bills is an oft cited example of medical malpractice. On Sunday, three doctors' associations representing thousands of doctors -neurologists, critical care specialists and palliative care doctors -came together to call for legislation that would prevent inappropriate medical treatment and give patients and families the right to refuse unnecessary intervention.
The Indian Society of Critical Care Medicine (ISCCM), Indian Academy of Neurology(IAN) and Indian Association of Palliative Care (IAPC) have come together to form an End of Life Care in India task-force (ELICIT) to develop an alternative draft bill to the one proposed by the health ministry. The ministry made public the draft Medical Treatment of Terminally-Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2016 in May with June 19 as the last day for submitting comments on it.
Doctors from the three societies were unanimous in rejecting the use of the word euthanasia anywhere in the discussion or in the bill.
Our legal system has mixed up end-of-life care with suicides and euthanasia. We abhor the term euthanasia and will not tolerate it in the legislation or in any discussion on end-of-life issues. You euthanise animals. Sentient human beings take charge of their last days," said Dr RK Mani of ISCCM, chairperson of the ELICIT steering committee.
ELICIT has called for a uniform definition of death, which will include brain death. "In India we are ready to declare brain death only if the patient is willing to donate organs. If they are not, we are not willing to certify brain death, which in effect means that you are actually ventilating a dead person," pointed out Dr Sanjay Nagral, a gastroenterological surgeon from Mumbai who is also a member of the editorial board of the Indian Journal of Medical Ethics.
Many doctors at the meeting talked of their daily experiences in dealing with end-of-life decisions. "It is an everyday occurrence when dealing with serious patients. So, the solution has to be local."
"The suggestion in the draft bill to approach the high court in such cases is just impractical, knowing how overburdened the judiciary is. And to say the high court will deliver a judgement in a month is ridiculous because terminally ill patients or acutely ill patients might not have a month left. ICU charges are Rs 35,000-50,000 excluding cost of drugs. Who will pay the bill at the end?" asked one of them.
Girish Gokhale, a senior lawyer assisting ELICIT in preparing the draft bill, said that instead of using the term right to die he would put it as the right to regulate treatment. He called upon doctors to explore the potential of providing palliative care as no fresh legislation was needed to do that.