Concepts and debates in end-of-life care

Debates in India on end-of-life care assumed a new life after the petition in the Supreme Court in the case of Aruna Ramchandra Shanbaug, calling for withdrawal of life-sustaining therapy from a patient in a persistent vegetative state. The Court's landmark decision has led the way for discussing and developing guidelines on various situations in end-of- life care. This paper discusses some key concepts in end-of-life care - medical futility, palliative care, advance directives, surrogate decision making, physician assisted suicide and euthanasia - with reference to the guidelines of various medical associations and decisions in Indian courts.