In News:

• The Ministry of Health and Family Welfare's draft guidelines (October 2024) aim to implement the Supreme Court's 2018 and 2023 orders on the right to die with dignity.

Legal Context: Supreme Court Rulings and Constitutional Rights

• Right to Refuse Treatment:
  • Common Law & Article 21: The right to refuse medical treatment is grounded in common law and is now recognized as a fundamental right under Article 21 of the Indian Constitution, following the 2018 Supreme Court judgment in Common Cause v. Union of India.
  • Supreme Court Rulings: The court's rulings in 2018 and 2023 affirmed that individuals have the constitutional right to refuse life-sustaining treatment and to die with dignity.

Withholding and Withdrawing Life-Sustaining Treatment

• Definition and Meaning:
  • What Is Life-Sustaining Treatment? Life-sustaining treatments, such as ventilators and feeding tubes, artificially replace vital bodily functions to sustain life.
  • Withholding/Withdrawal: This refers to discontinuing these treatments when they no longer improve the patient's condition or merely prolong suffering.
• When Is It Done?
  • End-of-Life Care: Withholding or withdrawing treatment is considered when further medical intervention is futile and would only artificially prolong the dying process.
  • Focus on Comfort: After withdrawing life-sustaining measures, the focus shifts to palliative care to alleviate pain and suffering.

Understanding Euthanasia and Misconceptions

• What Is Euthanasia?
  • Definition: Euthanasia refers to the intentional ending of a terminally ill patient’s life by medical professionals to relieve suffering.
  • Passive Euthanasia Misconception: In India, the term "passive euthanasia" is often mistakenly used to describe withholding or withdrawing life-sustaining treatment, but this does not involve the active killing of the patient.
• Legal Framework: The Indian Council of Medical Research (ICMR) clarified in 2018 that "passive euthanasia" is not a legally accepted practice in the country.

The Role of Doctors: Ethical Dilemmas and Shared Decision-Making

• Is Withdrawing Treatment "Giving Up" on the Patient?
  • Not Abandonment: Withdrawing life-sustaining treatment is not about abandoning the patient but recognizing when further interventions would cause unnecessary suffering.
  • Palliative Care: The patient’s comfort and dignity are prioritized through palliative care, which focuses on pain management and emotional support for both the patient and family.
• Doctors' Ethical Responsibility:
  • Shared Decision-Making: The process encourages a collaborative approach between doctors and the patient’s family or surrogate decision-makers. This joint decision-making ensures that the wishes of the patient are respected and relieves the doctor from bearing sole responsibility for life-and-death decisions.

Living Wills and Advance Medical Directives

• What Is a Living Will?
  • Definition: A living will is a legal document where a person outlines their medical preferences in the event they lose decision-making capacity.
  • Eligibility and Process: Individuals aged 18 or older, who are capable of making decisions, can draft a living will, naming at least two trusted surrogate decision-makers.
  • Legal Requirements: The document must be signed in the presence of an executor, two witnesses, and notarized to be legally binding.
• 2023 Supreme Court Guidelines: The Court simplified the procedure for making living wills to ensure that the right to die with dignity is upheld.

Medical Procedure for Withholding or Withdrawing Treatment

• Supreme Court Guidelines
  • The Supreme Court laid out a clear procedure for withholding or withdrawing life-sustaining treatment, emphasizing patient autonomy, expert assessments, and family consent.
• Primary and Secondary Medical Boards:
  • Primary Medical Board: The treating hospital sets up a Primary Medical Board, consisting of the treating doctor and two subject-matter experts, to assess the patient's condition and determine if life-sustaining treatment is appropriate.
  • Secondary Medical Board: A Secondary Medical Board, comprising independent experts, reviews the Primary Board's decision for added oversight.
• Consent from Family/Surrogate Decision-Makers:
  • The patient’s wishes, as outlined in an advance directive or by a surrogate, must be respected, and their consent is essential for proceeding with treatment withdrawal.
• Judicial Oversight:
  • Once the decision to withdraw treatment is made, the hospital is required to notify the local judicial magistrate, ensuring transparency and accountability.

Conclusion: Legal and Ethical Clarity in End-of-Life Care

• Shared Decision-Making: The process ensures that medical teams, families, and surrogate decision-makers collaborate, preventing any medical professional from facing moral or legal dilemmas alone.
• Protection of Autonomy: These frameworks and guidelines uphold patient autonomy, offering a legal and ethical pathway for terminally ill patients to exercise their right to die with dignity.