Context:
The Union Health Ministry has recently released the ‘Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients.’ This initiative seeks to establish a formal legal framework where previously only informal practices existed. Doctors have often informally advised families on withdrawing care for terminally ill patients, but the lack of formal guidelines has created a need for clear standards and protocols. Stakeholders are encouraged to provide feedback and suggestions on the draft by October 20, aiming to refine and formalize the approach to end-of-life care in India.
Relevance:
GS II: Health
Dimensions of the Article:
- Draft guidelines on passive euthanasia
- What is euthanasia, and what is a living will?
- Different countries, different laws
Draft guidelines on passive euthanasia
The draft guidelines on passive euthanasia provide a framework for the withdrawal or withholding of medical treatment in terminally ill patients. The guidelines address the following key points:
Defined Terminal Illness:
- Terminal illness is defined as an irreversible or incurable condition that leads to inevitable death in the foreseeable future.
Conditions for Withdrawal or Withholding of Medical Treatment:
- The individual is brainstem dead.
- A medical assessment confirms that the patient’s condition is advanced and unlikely to improve with further treatment.
- The patient or their surrogate provides informed consent to discontinue life support after understanding the prognosis.
- The procedure complies with the Supreme Court’s directives.
Patient Autonomy:
- Developed by AIIMS experts, the guidelines allow patients to decide on life support and resuscitation measures.
- The withdrawal of supportive care such as ventilation or dialysis is permitted if the patient is brain dead and unlikely to benefit from further interventions, provided the patient or surrogate refuses continued care.
Advance Medical Directives:
- Individuals may issue advance medical directives outlining their treatment preferences in case they lose the ability to make decisions.
Medical Board Review:
- If a physician determines that life-sustaining treatment is inappropriate, the case will be referred to a primary medical board for review.
- If the board concurs with the physician, a shared decision is made with the family, and a secondary medical board’s approval is required before life support is withdrawn.
What is Euthanasia, and what is a living will?
- Euthanasia refers to the practice of an individual deliberately ending their life, oftentimes to get relief from an incurable condition, or intolerable pain and suffering.
- Euthanasia, which can be administered only by a physician, can be either ‘active’ or ‘passive’.
- Active euthanasia involves an active intervention to end a person’s life with substances or external force, such as administering a lethal injection.
- Passive euthanasia refers to withdrawing life support or treatment that is essential to keep a terminally ill person alive.
- Passive euthanasia was legalised in India by the Supreme Court in 2018, contingent upon the person having a ‘living will’ or a written document that specifies what actions should be taken if the person is unable to make their own medical decisions in the future.
- In case a person does not have a living will, members of their family can make a plea before the High Court to seek permission for passive euthanasia.
Legality of Euthanasia in India
Passive Euthanasia:
- The Supreme Court of India in the landmark case Common Cause vs Union of India (2018) acknowledged the right of individuals to die with dignity.
- The ruling allows terminally ill individuals to opt for passive euthanasia and make a living will, enabling them to refuse medical treatment if they are suffering from an incurable illness or enter a vegetative state.
- The judgment permits individuals to specify in their living will that they should not be placed on life support in the event of an incurable coma.
- The right to die with dignity was recognized as part of the fundamental right to life under Article 21 of the Indian Constitution.
Active Euthanasia:
- Active euthanasia remains illegal in India and is considered a criminal offense.
- The only exception is when a person is declared brain dead, in which case life support can be withdrawn with the consent of the family.
Different countries, different laws
- NETHERLANDS, LUXEMBOURG, BELGIUM allow both euthanasia and assisted suicide for anyone who faces “unbearable suffering” that has no chance of improvement.
- SWITZERLAND bans euthanasia but allows assisted dying in the presence of a doctor or physician.
- CANADA had announced that euthanasia and assisted dying would be allowed for mentally ill patients by March 2023; however, the decision has been widely criticised, and the move may be delayed.
- UNITED STATES has different laws in different states. Euthanasia is allowed in some states like Washington, Oregon, and Montana.
- UNITED KINGDOM considers it illegal and equivalent to manslaughter.
-Source: Times of India
