ICMR drafts position paper 'Do Not Attempt Resuscitation' to guide physicians

The apex health research body ICMR has drafted a document to guide treating physicians take decision on whether or not to perform the cardiopulmonary resuscitation (CPR) in cases where a patient is suffering from an incurable disease and the chances of survival are extremely low, officials said.

The CPR is an emergency procedure that combines chest compressions often with artificial ventilation, performed in such patients as part of an effort to revive them.

The Indian Council of Medical Research (ICMR) has drafted a position paper 'Do Not Attempt Resuscitation (DNAR)' with the help of a multi-disciplinary team of experts, which would guide treating physicians to take the decision whether or not to perform the CPR on the background of incurable disease where the patient's chances of survival are extremely low, the officials said.

"Death is inevitable in certain situations at the terminal stage of disease, and providing CPR may only increase the suffering of such patients," Director General, ICMR, Dr Balram Bhargava said.

"The main purpose of the document is to not prolong the suffering of the patient, preserve the dignity in death and to preserve the mutual trust and respect between the treating physicians and patients," he added.

Bhargava said the document facilitates the process of informed decision making ensuring discussion, opportunity for a clear understanding in private about DNAR and its implications.

"Doctors would benefit from a guidance document to be able to discuss with their terminally ill patients on decisions related to do not attempt resuscitation," he said.

The document is the consequence of the efforts put in by a group of experts to help overcome the increasing psychological, emotional and financial burden on the patients and their families, the officials said.

The position paper will be finalised for the release soon based on the inputs from the national consultation, they said.

The document highlights that the treating physician should deliver complete information to patient or surrogate to enable them to understand the implications of CPR in the context of incurability of the disease and the almost impossible chance of meaningful survival or quality of life, and to understand DNAR, the officials said.

The document, they said, also provides an algorithm for DNAR decision making which would guide the physicians in making the right decisions about treatment on case to case basis.

It also stresses about the importance of continuing supportive and compassionate care of the patient, the officials said.

The patient or surrogate information sheet in the document clarifies the terminologies that have been used to explain in simple words how the decisions would be arrived at by the treating doctor, they said.

The document also has a one page DNAR form on which the wishes of the patient, surrogate and physician would be recorded, they added.