AIIMS-Delhi Initiates Weekly OPD to Educate Patients on Medical Decision-Making and Advance Directives

AIIMS-Delhi is set to introduce a weekly outpatient department (OPD) aimed at educating patients about their medical treatment preferences in case they lose decision-making capacity due to illness or accident. This initiative follows the Union health ministry's draft guidelines on withdrawing life support for terminally ill patients. Dr. Sushma Bhatnagar, head of the Dr. B R Ambedkar Institute Rotary Cancer Hospital at AIIMS, shared that the cancer institute will offer counselling on Advance Medical Directives (AMD) and assist in creating these legal documents.

Advance Medical Directives and Patient Autonomy

An Advance Medical Directive (AMD) is a written statement by an individual with decision-making ability, outlining their medical treatment preferences if they become incapacitated. Dr. Bhatnagar explained that AMDs allow individuals to decide on their treatment while they are still mentally sound, ensuring their wishes are respected if they later lose decision-making capacity. The principle of palliative care is to alleviate suffering without unnecessarily prolonging life through life support.

The Supreme Court recognised AMDs as legally valid documents in 2018, providing guidelines for their implementation. Initially, executing an AMD required visiting a judicial magistrate, but now it can be done before a notary or gazetted officer. Advocate Dhvani Mehta highlighted that the core of medical ethics is respecting patient autonomy, even when they lose decision-making capacity due to conditions like dementia or stroke.

Implications of Life Support Decisions

The draft guidelines emphasise that life support should not be initiated for terminally ill patients unlikely to benefit from it, as it may increase suffering and compromise dignity. Many ICU patients are terminally ill and do not gain from life-sustaining treatments (LST), which can lead to unnecessary burdens and suffering. Such treatments also cause emotional stress and financial strain on families and moral distress for caregivers.

Dr. Bhatnagar noted an increase in people creating AMDs since the Supreme Court's 2018 ruling. Promoting AMDs is crucial not due to resource constraints but to guide medical treatment appropriately. She stressed the importance of "death literacy" alongside health literacy, advocating for informed decisions about end-of-life care without isolating patients from their families.

The guidelines suggest that doctors should carefully consider whether starting life support measures in terminally ill patients is beneficial or harmful. Excessive and inappropriate LST can lead to avoidable burdens on patients and families, highlighting the need for thoughtful decision-making in such cases.

As AIIMS-Delhi prepares to launch this initiative, it aims to empower patients with knowledge about AMDs, ensuring their treatment preferences are respected even when they cannot communicate them directly.