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Polity & Governance
Mahesh

26/10/24 10:37 AM IST

The right to die with dignity

In News
  • The Ministry of Health and Family Welfare released draft Guidelines for the Withdrawal of Life Support in Terminally Ill Patients to operationalise the Supreme Court’s 2018 and 2023 orders on the right to die with dignity for all Indians.
Guidelines
  • Setting up of Primary and Secondary Medical Boards at the level of the hospital, which will determine when further medical treatment may not be beneficial to a terminally ill patient;
  • Nomination of doctors by the district Chief Medical Officer or equivalent to hospital-level Secondary Medical Boards, which will confirm or reject the opinion of the Primary Medical Boards.
  • The treating hospital constitutes a Primary Medical Board to assess the patient’s condition, and to recommend the appropriateness of withholding/ withdrawing life-sustaining treatment. The board is composed of the treating doctor and two subject-matter experts with at least five years of experience.
  • To ensure another level of checks, a Secondary Medical Board, also set up by the hospital, reviews the decision of the Primary Medical Board. The Secondary Medical Board comprises a registered medical practitioner nominated by the district Chief Medical Officer, along with two subject-matter experts with at least five years of experience. All these members must be different from those on the Primary Medical Board.
  • The persons nominated by the patient in the advance medical directive or surrogate decision-makers (where there is no directive) must consent to the withholding or withdrawal of treatment.
  • The hospital must notify decisions on withholding/ withdrawing life-sustaining treatment to the local judicial magistrate.
Living will
  • To enforce the right to die with dignity, the Supreme Court in its 2018 judgment also laid down the framework for making advance medical directives or living wills. However, the process was complex, and the court simplified it in its 2023 judgment.
  • Just like wills on how one’s property is to be distributed, living wills are written documents made by a person of age 18 years or older with decision-making capacity, expressing their will on how they would wish to be treated if they lose such capacity.
  • The document should detail at least two surrogate decision-makers — anyone whom the person trusts, from family to neighbours, who can make decisions on behalf of the person if they lose decision-making capacity.
  • The document becomes legal when it is signed in the presence of an executor and two witnesses, and attested before a notary or gazetted officer.
Euthanasia
  • Euthanasia is the intentional killing of a terminally ill patient by the doctor for the good of the patient.
  • The expression “passive euthanasia” is often used in India to refer to the withholding or withdrawal of life-sustaining treatment.
  • The use of this term is one of the major reasons for the misconception and apprehension towards the idea of the right to die with dignity.
  • A glossary of definitions by the Indian Council of Medical Research (ICMR) in 2018 demonstrated that “passive euthanasia” is misinterpreted, and does not have social acceptability.
  • The withholding or withdrawal of life-sustaining treatment also includes ‘do-not-attempt-resuscitation’ orders.
  • The order is issued by the treating physician, who is well versed with the medical condition of the patient, in consultation with the patient or their family or surrogate decision-maker.
Source- The Hindu

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