The death of Asha Bhosle has rekindled debate in Indian medical circles over end-of-life care in ICUs, particularly when chances of meaningful recovery are minimal.

Fear of legal consequences, entrenched habits, and discomfort among doctors and patients’ families in discussing death, some physicians say, often influence decisions on interventions like cardiopulmonary resuscitation (CPR) more than clinical judgement or patients’ interests. The debate, playing out on social media platforms, reflects persistent disagreement over what constitutes appropriate end-of-life care among doctors, seven years after the Indian Council of Medical Research issued guidelines for do-not-resuscitate decisions.

Shriprakash Kalantri, professor of medicine at the Mahatma Gandhi Institute of Medical Sciences near Wardha, wrote on X: “Reports that Asha Bhosle received CPR are distressing. I truly hope they are untrue."

Kalantri said: “A life of such music and grace deserves a dignified farewell, not the trauma of futile ICU rituals,” Kalantri also wrote. “True care means knowing when not to use machines. Sometimes the deepest act of respect is letting go…”

Details of what treatment Bhosle received, including whether she was administered CPR, remain unclear. An official at the hospital where she was treated said such information is not disclosed.

There is no confirmation that Bhosle was administered CPR. The debate among doctors reflects broader concerns about end-of-life care rather than the specifics of her treatment. Kalantri said his post was based on an assumption that CPR had been administered, as is common practice.

Even so, he said the moment warrants reflection.

He described it as an opportunity for the medical profession and the public to reflect on aggressive treatment practices that may prolong the agony of patients and their families or leave patients dying in isolation inside ICUs.

“Most Indian doctors have no training in end-of-life care, cannot recognise (the process of) active dying, and cannot communicate this effectively with patients and families,” Roop Gursahani, a neurologist at the Hinduja Hospital in Mumbai, wrote on X on Tuesday.

Such concerns persist despite formal guidance.

A 2019 position paper from the ICMR was intended to guide doctors on decisions not to initiate CPR in patients whose suffering would only be prolonged if they are revived.

Specialists involved in drafting it say chances of meaningful recovery after CPR are minimal in terminally ill patients, those actively dying, or the very aged who are also seriously ill.

CPR also carries risks, they say.

“Revival through CPR often leaves patients with serious brain damage, bed-bound, or disabled,” said Raj Kumar Mani, a critical care specialist in New Delhi who helped draft the ICMR position paper. “There are states worse than death.”

On average, Mani said, only between 10 per cent and 15 per cent of patients revived through CPR have a quality of life that can be considered meaningful.

However, not all doctors agree on limiting intervention.

“CPR is different from ventilation — it provides an opportunity to revive the heart. Even in the case of the very elderly, the decision on CPR should be left to the family and the physician on the spot,” said R.V. Asokan, former national president of the Indian Medical Association.

Practice, however, has been slow to change. “Someone has to actively promote the ICMR policy paper, raise awareness about it, or enforce it,” Gursahani told The Telegraph. “More doctors need to learn to discuss imminent death with patients and families.”

Kalantri said the milieu often determines how doctors approach CPR decisions. In large private hospitals, practice can veer towards “hyperdefensive medicine”, where every possible intervention is used to prevent death.

“The fear of legal consequences also likely influences such decisions,” he said. “In a rural public hospital such as ours, it is likely easier to discuss with patients and their families, to help alleviate any guilt in accepting death as an outcome.”

He added that aggressive and prolonged treatment is more often seen among wealthier patients, who are exposed to longer ICU stays and higher medical interventions.

At the same time, doctors stress CPR remains vital in appropriate cases.

There is broad agreement that its use in younger patients with a high likelihood of recovery is not in question. At the MGIMS itself, Kalantri noted, an emergency room team performed four CPR cycles for over 45 minutes to revive a 26-year-old who has since returned to a normal life.