End-of-life care policy: An integrated care plan for the dying.

Sir,

We would like to appreciate the great work of Myatra et al.[1] for bringing out the much needed end-of-life care policy under the banner of Indian Society of Critical Care Medicine and Indian Association of Palliative Care. In India, we the doctors are not only the health care providers, but also don the role of a friend, philosopher and guide to the family of our patients. Most of us do get approached by the relatives of many elderly patients who are ailing in the multi speciality Intensive Care Units (ICUs) of reputed tertiary care hospitals for help in decision making. In variably, they want us to guide them whether to continue ventilation, give consent for hemodialysis or continuation of expensive anti-microbial medications, etc., With very limited knowledge about the patient's present condition and nonavailability of investigation data, we will be in great dilemma to guide them.[2]

We would like to submit an additional and practical suggestion to the already formed end-of-life care policy. Every multi speciality ICU of tertiary care hospital should set up an end-of-life care support unit. The said unit should be headed by one of the senior most physician/professor of medicine (preferably recently retired and who can spare time to the needy), a social worker and a legal adviser as other members of the unit. The relatives of the patient who is in need for end-of-life care should initially approach the treating doctors who in turn refer the relatives to the end-of-life care support unit. The unit members, after judicious discussions with the treating doctors, guide the relatives to opt for end-of-life care or not with due completion of the legal formalities. We are of the opinions that, this arrangement will definitely safe guard the interests of all the concerned parties.