Monday, August 26, 2019

FICCI-ELICIT Action Plan for end-of-life care and decision-making for patients

Dr KK Aggarwal

Federation of Indian Chamber of Commerce and Industry (FICCI) and End of Life Care in India Taskforce (ELICIT) have also released an information guide to improve and facilitate execution of end-of-life decisions for patients and their families, in addition to their guide for doctors and hospital administrators

Here are excerpts from the “Action Plan for end-of-life care and decision-making” for patients.

“Plan in Advance: Self-awareness is the beginning of any journey. Think about how and where you would like to die.

Do not be afraid to bring up the subject of death if you feel it is relevant to you: Senior citizens or those with serious or life limiting illness should proactively assume the responsibility of discussing their future medical care preferences with family and loved ones and their treating doctors.

Ask your treating doctor and medical team about various options available to you and the advantages and disadvantages associated with each of them: It is important to remember that you cannot be forced to accept life-sustaining treatment against your wishes. Your treating doctor and medical team have an ethical and legal obligation to respect your wishes if you refuse any offered treatment, after understanding the consequences of such refusal.

To prepare for situations when you may not be in a position to express your wishes, make an Advance Medical Directive (AMD): An Advance Medical Directive has two components:

1.     The Living Will, which expresses your wishes for care clearly so that doctors can understand and follow them
2.     The appointment of a healthcare proxy, through a power-of-attorney, who can speak for you when you are no longer capable of doing so. Your healthcare proxy could be a member of your family or a friend, but should not be your treating doctor. This saves the family the agony of taking decisions on your behalf without any guidance or without knowing your wishes

Discuss your directive with your family and/or healthcare proxy and make sure that they accept the appointment. It is advisable to make the directive in the presence of two witnesses, who will attest to the fact that you have made the directive with a sound mind. This directive can be revoked verbally/in writing. Although at present the Supreme Court has mandated a rather cumbersome process for using these directives, rationalization of the process is being advocated for.

Take charge and accept death as part of life: If a serious or terminal illness is diagnosed, prepare to take charge of the last days of your life. Use all sources medical, social, psychological and spiritual, to live well till the end. Do not resist the natural course of death. Discuss your needs and expectations now and in the future with family members, doctors and trained counsellors. If you realize that you would rather not know or engage with such matters, appoint a trusted surrogate decision maker.”

(Source: FICCI-ELICIT Improving end-of-life care & decision-making information guide to facilitate execution of end-of-life decisions - for patients and their families)

See related link:

FICCI-ELICIT guide to improving end-of-life care & decision-making

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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