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Mahesh

03/12/24 10:01 AM IST

UK’s assisted dying bill

In News
  • The UK House of Commons has voted in favour of the bill which allows terminally ill patients to request assistance to end their own life.
Euthanasia/ Assisted dying
  • Alleviates suffering: Provides relief from chronic misery and vegetative states; offers a humane way to end prolonged suffering.
  • Preserves patient’s dignity & autonomy: By recognizing the patient's right to make end-of-life decisions.
  • Professional & ethical approach: As it involves careful evaluation by a medical board; includes legal pre-scrutiny to prevent potential misuse, etc.
    Cons:
  • Ethical & moral challenges: Conflicts with medical ethics of preserving life; creating a moral dilemma for physicians trained to save lives.
  • Risk of misuse: Danger of vested interests (e.g., organ transplantation considerations), etc.
  • Sociocultural & philosophical sensitivities: Conflicts with cultural and religious beliefs (e.g., Christian theology) about life and death.
  • E.g., Immanuel Kant says that the voluntary act of destroying oneself can “never, under any circumstances, be regarded as allowable.”
Provisions of the bill
  • The Bill says that only a terminally ill person above the age of 18 and with the mental “capacity” to make such a decision can request assisted dying.
  • It also says that the patient must be registered, and residing in England or Wales for 12 months before the request.
  • The Bill defines a terminally ill person as someone who has a worsening illness, disease or medical condition that “cannot be reversed by treatment”, and will result in a death that can “reasonably be expected within 6 months”.
  • It also explicitly excludes persons with disabilities or “a mental disorder”.
  • A person making an assisted dying request must sign a “first declaration” in the presence of a “coordinating doctor” — a qualified doctor willing to provide such assistance — and another person.
  • The coordinating doctor will then make a “first assessment” to make sure that the patient meets the qualifications to make a request for assisted dying, and has done so voluntarily.
  • If the doctor is satisfied that all these conditions have been met, they will refer the request to a second “independent docto”’ who will make the same determination after an at least seven-day-long “first period of reflection”.
  • In case the independent doctor refuses to agree with the assessment of the coordinating doctor, the latter may refer the request to another independent doctor (though this can only be done once).
  • If both the coordinating and independent doctors agree to the request, it is then sent to the High Court of Justice in London where the court will determine if all the requirements have been met to grant the request. The court can hear and question both the patient and the two doctors.
  • If it refuses the request, the patient can challenge the decision before the Court of Appeal.
  • If either the High Court or Court of Appeal grant the request, a “second period of reflection” will begin.
  • After 14 days the patient will be allowed to sign a “second declaration” to confirm their request for assisted dying, witnessed by both doctors and a third person.
Passive euthanasia’ in India
  • In 2018, the Supreme Court of India held that the “right to die with dignity” formed a part of the right to life with dignity under Article 21 of the Constitution of India, and recognised the legality of “passive euthanasia” — the withdrawal of life support from terminally ill patients or patients in a “permanent vegetative state”.
  • This allows the patient to die a natural death in the absence of medical interventions, as opposed to the assisted dying bill which gives patients a more active role in choosing when to die.
  • The SC also provided guidelines to give effect to passive euthanasia, both in cases where the families consent must first be taken or in cases where the patient leaves behind a “living will” or an “advance medical directive” authorising the withdrawal of life support in certain situations.
  • Among the guidelines was the condition that the living will must be signed in the presence of two witnesses, and signed by a Judicial Magistrate.
  • The guidelines also called for multiple approvals before the terminally ill patient’s case is cleared — from the treating physician, a suitably qualified medical board, and another external medical board, with representation from the local administration.
  • However, in 2019 the Indian Society of Critical Care Medicine filed an application to modify the guidelines, calling them cumbersome and unworkable.
  • Though the court modified the guidelines in 2023 to introduce strict timelines at each stage and limit the involvement of the Judicial Magistrate, the awareness of these guidelines and their implementation across the country has been limited.
Source- Indian Express

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