Reflections on the ICMR 2020 Consensus Guidelines on Do Not Attempt Resuscitation

Area of Science:

• Medical Ethics
• Clinical Practice Guidelines
• End-of-Life Care

Background:

• Inconsistent practices like futile cardiopulmonary resuscitation (CPR) and ethical uncertainty complicated end-of-life care in India.
• Lack of standardized protocols led to prolonged patient suffering despite poor prognosis.

Purpose of the Study:

• To evaluate the impact and adoption of the 2020 Indian Council of Medical Research (ICMR) Consensus Guidelines on Do Not Attempt Resuscitation (DNAR).
• To identify barriers to the uniform implementation of DNAR guidelines in Indian hospitals.

Main Methods:

• Analysis of the ICMR's 2020 Consensus Guidelines on DNAR.
• Review of clinical practices and ethical considerations prior to guideline implementation.
• Assessment of guideline dissemination and adoption challenges.

Main Results:

• The guidelines introduced standardized protocols, documentation, and legal clarity for DNAR in India.
• Key principles include shared decision-making, compassionate care, and maintaining patient dignity.
• Limited dissemination currently hinders widespread awareness and consistent adoption.

Conclusions:

• The ICMR DNAR guidelines address critical gaps in Indian end-of-life care.
• Enhanced dissemination, hospital education, and policy promotion are crucial for effective implementation.
• A revised guideline edition is needed to incorporate practical insights and overcome adoption barriers for equitable care.