title: End-of-life care policy: An integrated care plan for the dying: A Joint Position Statement of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Association of Palliative Care (IAPC).
abstract: OBJECTIVE
  The purpose was to develop an end-of-life care (EOLC) policy for patients who are dying with an advanced life limiting illness and to develop practical procedural guidelines for limiting inappropriate therapeutic medical interventions and improve the quality of care of the dying within an ethical framework and through a professional and family/patient consensus process.
  
  
  METHODS
  The Indian Society of Critical Care Medicine (ISCCM) published its first guidelines on EOLC in 2005 [1] which was later revised in 2012.[2] Since these publications, there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed observational studies, surveys, randomized controlled studies, as well as guidelines and recommendations, for education and quality improvement published across the world. The search terms were: EOLC; do not resuscitate directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; EOLC in India; cultural variations. Indian Association of Palliative Care (IAPC) also recently published its consensus position statement on EOLC policy for the dying.[3].
  
  
  METHODS
  An expert committee of members of the ISCCM and IAPC was formed to make a joint EOLC policy for the dying patients. Proposals from the chair were discussed, debated, and recommendations were formulated through a consensus process. The members extensively reviewed national and international established ethical principles and current procedural practices. This joint EOLC policy has incorporated the sociocultural, ethical, and legal perspectives, while taking into account the needs and situation unique to India.
authors.affiliation: Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Pune, Maharashtra, India.
authors.forename: Sheila Nainan
authors.initials: SN
authors.lastname: Myatra
authors.affiliation: Department of Palliative Medicine, Tata Memorial Hospital, Pune, Maharashtra, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Salins
authors.affiliation: Department of Critical Care, Bharati Vidyapeeth, University Medical College, Pune, Maharashtra, India.
authors.forename: Shivakumar
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Palliative Care Program of Christian Medical Association of India, Bangalore, Karnataka, India.
authors.forename: Stanley C
authors.initials: SC
authors.lastname: Macaden
authors.affiliation: Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Pune, Maharashtra, India.
authors.forename: Jigeeshu V
authors.initials: JV
authors.lastname: Divatia
authors.affiliation: Department of Palliative Medicine, Tata Memorial Hospital, Pune, Maharashtra, India.
authors.forename: Maryann
authors.initials: M
authors.lastname: Muckaden
authors.affiliation: Cipla Palliative Care and Training Centre, Mumbai, Maharashtra, India.
authors.forename: Priyadarshini
authors.initials: P
authors.lastname: Kulkarni
authors.affiliation: Karunashraya Hospice, Bangalore, Karnataka, India.
authors.forename: Srinagesh
authors.initials: S
authors.lastname: Simha
authors.affiliation: Department of Pulmonology, Critical Care and Sleep Medicine, Saket City Hospital, New Delhi, India.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Mani
keywords: Care of the dying; end-of-life care in India; medical futility; position statement; terminal care; withholding and withdrawing