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Context:

The Ministry of Health and Family Welfare has introduced draft guidelines for withdrawing life support in terminally ill patients.

Background

Life-sustaining treatment includes medical interventions—like ventilators and feeding tubes—that help to replace crucial bodily functions when a person cannot function on their own.

Withholding treatment means not starting certain treatments when it’s clear they won’t benefit the patient. Withdrawing treatment means stopping continuing treatments when they no longer help to improve the patient’s quality of life. Both actions are considered compassionate care, letting the person pass away naturally without unnecessary medical procedures.

Highlights of the Guidelines

The guidelines recommend setting up two levels of medical boards within hospitals to ensure the patient's wishes are respected while also protecting the doctors legally.

Primary Medical Board: This includes the treating doctor and two experienced specialists. They decide if life-sustaining treatment should be stopped, considering if further medical interventions would only cause suffering.
Secondary Medical Board: This is a review team, with different doctors appointed by the district’s Chief Medical Officer. They double-check the decision made by the Primary Board to ensure it’s correct.

The guidelines focus on shared decision-making by involving doctors, family members, and designated decision-makers, this respect, patient rights and families in critical decisions, and legally protecting professionals from full responsibility for difficult decisions.

The hospital must notify the local Judicial Magistrate about the decision to withhold or discontinue life-sustaining treatment, providing a legal layer of control to the process.

Right to Die with Dignity

The right to die with dignity focusses on a person's rights to choose how and when to die, especially in situations of terminal disease or extreme suffering.

Many countries including the Netherlands and Belgium have legalised euthanasia and physician-assisted dying, indicating a growing respect of individual autonomy over life and death decisions.

Article 21 of the Indian Constitution guarantees the right to life and personal liberty. This article has been interpreted by the Supreme Court to include the right to live with dignity, extending to the right to die with dignity when life becomes unbearable due to pain or suffering.

Supreme Court Rulings

In the Aruna Shanbaug Case (2011), the Supreme Court held that under specific conditions passive euthanasia is legal, the court also recognised the importance of compassion and empathy in cases where patients are unable to communicate their intentions.

In the case of Common Cause v/s Union of India (2018), the Supreme Court permitted living wills, the court emphasised that this right is critical for human autonomy and dignity at the end of life, and the court simplified the criteria in 2023.

Do-Not-Attempt-Resuscitation (DNAR) Orders

DNAR orders inform healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops, such orders must be respected as part of the patient’s autonomy and their right to die with dignity.

Challenges

The debate over the right to die with dignity; Supporters say that people should have the autonomy to choose to end their suffering, highlighting the significance of compassion. Opponents raise concerns about the potential for abuse, fearing that vulnerable individuals may feel pressured to choose death.

Legal and bureaucratic hurdles complicate the process, lack of precise guidelines and confusion among healthcare providers can lead to delays and additional suffering for patients.

Way Forward

There is a need for detailed guidelines for healthcare providers regarding end-of-life care and decision-making processes.

Empower medical practitioners in the legal issues of euthanasia and supportive care, so they can handle difficult discussions with patients and families.

Public awareness about the right to die with dignity, education campaigns can assist people to understand the concepts of euthanasia and allow them to make educated choices regarding their end-of-life care.

Must Read Articles:

ENSURING DIGNITY FOR THE TERMINALLY ILL

PASSIVE EUTHANASIA

Source:

Indian Express