Health Ministry gives patients right to refuse ICU in new guidelines

Hospitals cannot admit critically ill patients in intensive care units (ICUs) in case of an informed refusal by them or their relatives, according to guidelines released by the Ministry of Health and Family Welfare.

In a first of its kind measure, the health ministry released guidelines underlining the criteria for hospitals for admission and discharge of patients in ICUs. The guidelines were compiled by a body of 24 experts having different levels of expertise in critical care medicine.

Speaking on the ethical rights of patients and next of kin to allow admission to ICU, Amit Goel, director and head, critical care medicine, Yatharth Hospital said that the recently released guidelines uphold patient autonomy by allowing patients or their next of kin to refuse ICU admission. “At the same time, they also emphasise the need for informed consent - hospitals and doctors should clearly explain the need for and implications of ICU care so patients and families can make decisions based on a comprehensive understanding of the situation,” he added.

The guidelines recommend that ICU care for terminally ill patients who do not have any chance of survival is a futile exercise. Further, anyone with a living will or advanced directive against ICU care should not be admitted to the intensive care units.

The expert body has recommended that the criteria for admitting a patient to ICU should be based on the need for organ support or in anticipation of deterioration in the medical condition.

Altered level of consciousness, hemodynamic instability such as clinical features of shock and arrhythmias, and need for respiratory support have been listed as the criteria for admitting patients in ICUs.

According to the newly released guidelines, blood pressure, pulse rate, respiratory rate, oxygen saturation, urine output, and neurological status among other parameters should be monitored in all patients admitted to ICU.

Calling the guidelines long overdue, Goel said that the recommendations will help standardise protocols across hospitals and bring much-needed clarity on the appropriate use of scarce critical care resources, especially during public health emergencies.

“The guidelines preserve the physician's discretion in making admission decisions based on each patient's unique medical status and prognosis while also providing broad criteria for prioritising patients that stand to benefit the most from intensive interventions,” he added.