PIL Filed In Bombay High Court Challenging MOHFW Guidelines On ICU Treatment Decisions

PIL Filed In Bombay High Court Challenging MOHFW Guidelines On ICU Treatment Decisions

The MOHFW, in December 2023, published “ICU Admission and Discharge Criteria” stating that a decision can be taken by an individual patient, relative or doctor without constitution of any medical committee.

Urvi MahajaniUpdated: Sunday, June 16, 2024, 01:17 AM IST
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Bombay High Court | File pic

A public interest litigation has been filed in the Bombay High Court challenging the December 2023 guidelines issued by the Ministry of Health and Family Welfare (MOHFW) that allows a patient, a relative or a doctor to decide not to admit or to stop  treatment in an intensive care unit (ICU) without formation of a medical committee or reporting to any authority. 

The PIL by Medico Legal Society of India, a Pune based association of doctors and lawyers, states: “Any person with malicious intent may be in a position to decide about the life and death of others. This is akin to active euthanasia which is not permitted in India.”

The Supreme Court, on January 24, 2023, modified an earlier 2018 judgment which provided the procedure to be followed for handling situations when a patient is suffering from a medical condition “with no hope of recovery” and continued on life support, whether the patient has given advance directive or otherwise. 

As per the 2018 judgment, the treating physician has to make a request and form a three-doctor committee to examine the patient within 72 hours. A second three-doctor committee would then be formed by the Judicial Member First Class (JMFC) within 72 hours. Only after the JMFC approves, the treatment would be stopped.

The apex court, January 2023, reduced the period  for decision by the two committees from 72 hours to 48 hours each thereby reducing the time from medical decision from 6 days to 4 days. It also removed the need to for JMFC approval. It stated that the district civil surgeon will inform the JFMC about the committee's decision.

The MOHFW, in December 2023, published “ICU Admission and Discharge Criteria” stating that a  decision can be taken by an individual patient, relative or doctor without constitution of any medical committee. 

Opposing this, the PIL stated that they are against the SC judgment. “Right to life of the patient and right to profession of the medical professionals is therefore at a jeopardy because of these guidelines  issued by MOHFW,” the petition contended.

It claimed that the guidelines have been released for the government’s  popularity in citizens' minds as if  saving patients  from unnecessary treatments by doctors. However, the same is causing hardship to the doctors in their daily work. “Whether to treat the patient in a situation where there is threat to 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 would be crucial for saving the patient  and protecting his life …,” the PIL added. 

The plea also referred to a August 1989 judgment which directed doctors to keep all issues, including consent and legal formalities aside, and stabilise patients. Whereas, the January 2023 judgment gives doctors time to decide whether treating the patient is futile or otherwise. However, the latest guidelines by the MOHFW are creating “hurdles for doctors”. 

The guidelines may sound an easy way for patients  and their relatives to discontinue prolonged and expensive treatment. “However it does not  mean that power should be transferred to patients, their relatives and individual doctors who can make decisions to stop the treatment,” the PIL underlined. With modern equipment and medicines it is possible to help patients. 

The petitioner has approached the ministry before filing the PIL. The HC will hear the PIL on June 24. 

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