Recommendations to the Maharashtra Task Force to Manage Critically Ill Covid-19 Patients

Managing end of life care during a pandemic

Summary: Vidhi recommends the use of Do Not Attempt Resuscitation decisions, the provision of palliative care and the development of triage protocols, along with clear information for patients during the Covid-19 pandemic.

The Government of Maharashtra constituted a task force of doctors to give recommendations regarding a patient management protocol for critically Ill Covid-19 Patients. The Vidhi Centre for Legal Policy submitted recommendations regarding Do Not Attempt Resuscitation decisions, withdrawing and withholding life-sustaining treatment, palliative care and the need for pandemic triage protocol which could be considered by the Task Force in framing its own recommendations. Some of our key suggestions include:

• Develop protocols on the use of Do Not Attempt Resuscitation to guide decisions about CPR in Covid-19 patients.

• Consider emergency legislative intervention to replace the Supreme Court guidelines on withholding and withdrawing life-sustaining treatment with practical, workable guidelines. Alternatively, develop protocols on withholding or withdrawing life-sustaining treatment that lay down criteria for initiating end of life care discussions, rely on shared decision making amongst physicians and/or their near relatives and require clinical ethics committees to participate in such decisions.

• Make arrangements for the provision of adequate and quality palliative care for critically ill Covid-19 patients at the end of life.

• Prepare pandemic triage protocols based on consistent ethical principles which are not arbitrary or discriminate solely on the basis of factors such as age, disability etc., in anticipation of a surge in patients.

• Prepare clear and simple information in multiple languages for patients about the above protocols, including the rationale underlying them.

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