GOI ICU guidelines giving enormous power in the hands of any individual, doctors or relatives, to end the life of another person: Petition filed in Court

Mumbai: Calling the guidelines for Intensive Care Unit Admission and Discharge Criteria, released by the Directorate General of Health Services (DGHS) unconstitutional and violative of the Supreme Court order, a Public Interest Litigation (PIL) has been filed in the Bombay High Court praying for the dismissal of the same.

Agreeing to consider the plea, the Bombay High Court bench of Chief Justice Devendra Kumar Upadhyaya and Justice Arif S. has issued notice to the Union Health Ministry and the Central Government. The matter has been listed for further hearing on April 23, 2024.

Medical Dialogues had earlier reported that last year in December, the Union Health Ministry, for the first time, released an Expert Consensus Statement defining patients' admission and discharge criteria to the Intensive Care Unit (ICU) and other related details.

These guidelines for Intensive Care Unit Admission and Discharge Criteria, compiled by a total number of 24 experts and released by the Directorate General of Health Services (DGHS) operative under the Union Health Ministry, addressed several issues including ICU Admission criteria and specifically it defined the critically ill patients who should not be admitted to the ICU.

Filing the PIL, the Medico-Legal Society of India (MLSI) has claimed that the concerned ICU guidelines not only violate Article 19(1) and Article 21 of the Indian Constitution, but it is also in contravention of the Supreme Court order issued on 24th January 2023.

While considering a plea by the Indian Society of Critical Care Medicine, the Supreme Court bench last year considered the legal question whether even in the absence of Advance Directives, when a person is faced with a medical condition with no hope of recovery and is continued on life support system/medicines, life support system should be withdrawn.

Through the order dated 24th January 2023, the Supreme Court clarified that to withdraw the life support to such patients first a committee of 3 doctors formed by the treating physician has to examine the patient for 48 hours, and thereafter a second committee of 3 doctors formed by the District Civil Surgeon needs to examine the patient for a period of 48 hours and report the condition to the JFMC. Treatment can be stopped under the District Civil Surgeon's approval under intimation to JFMC. 

Even though earlier, each committee was required to examine the patient for 72 hours and the approval from the JFMC was mandatory, through the 2023 order, the Supreme Court reduced the observation period from 72 hours to 48 hours for each committee and obliviated the need to approach JFMC. However, even after last year's order from the Supreme Court, the decision to discontinue treatment has to be taken by committees of 3 doctors, highlighted the PIL.

Meanwhile, the ICU guidelines, released by the Union Health Ministry in December 2023 mentioned that such a decision can be taken by an individual doctor or individual relative of the patient without the constitution of such two committees of three doctors each, giving "enormous power in the hands of any individual or medical professional to end the life of another person."

"Right to life of the patient and Right to profession of the medical professionals is therefore at jeopardy because of these guidelines issued by the MOHFW," argued the PIL.

The petitioner association also objected to the rules specifying which patients should not be admitted to the ICU and some of the provisions of the ICU Discharge Criteria mentioned in the guidelines. Referring to these rules, the association claimed that these rules are in contravention of the Supreme Court order. It argued that such situations should be handled on three different levels - Medical, Legal and Administrative- by three different authorities.

"MOHFW Guidelines permit that any patient or his relative or any individual doctor can decide not to admit in ICU or stop treatment in ICU, without formation of any medical committee or reporting to any authority. Any person with malicious intent may be in a position to decide about the life and death of others. This is akin to active Euthenesia which is not approved in India," stated the plea.

"While all members of medical fraternity understands the agony of relatives due to financial drain on the patient "suffering from treatment" and doctors knowing futility of treatment, it is necessary that the right to life of the patient under Article 21 of constitution of India must also be protected by the treating physicians, hospital and the State," it further added.

"Since these guidelines appear to have been released for popularity for the Government in the minds of citizens as if the government has released these guidelines to save patients from unnecessary treatments by doctors, this is causing hardship for the doctors in their day to day work. Whether to treat the patient in a situation where there is threat to his life or to convince the relatives of the patient that the patient needs, treatment in the ICU is becoming a big challenge. Important time is lost which could be crucial for saving the patient and protecting his right to life under Article 21 of the constitution," the association stated in its plea.

The plea claimed that the MOHFW guidelines on ICU admission and discharge criteria are creating hurdles in the performance of duties of the doctors and their right to profession under Article 19(1) g is getting violated.

In the PIL, the association opined that the guidelines should help to improve doctor-patient relationships and not create differences of opinions among doctors, patients and their relatives and added, "Unfortunately, these guidelines are likely to create points of friction between relatives of serious patients and doctors who feel that the patient needs to be given a chance of survival. It will also force some doctors in favour of the decision of the patient e.g. family doctors to stand against the treating doctors and these differences of opinions amongst doctors are likely to create air of suspicion among the relatives leading to complete disruption of faith in the medical system."

To view the HC order, click on the link below:

https://medicaldialogues.in/pdf_upload/bombay-hc-order-234278.pdf

Also Read: GOI Releases Expert Consensus Statement on ICU Admission and Discharge Criteria, Key Takeaways