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.

Why is it in the News?

The University Grants Commission (UGC) has been issuing regulations, guidelines and directives at breakneck speed that some of the important ones miss drawing the attention of the higher education community.

Context:

• The University Grants Commission (UGC) has introduced Mulya Pravah 2.0 to enhance the ethical landscape of higher education institutions.
• This evolved guideline, succeeding its 2019 predecessor, aims to instil human values and professional ethics, actively combating unethical practices that have permeated various institutions.
• The primary focus involves constructing value-based institutions that resonate with fundamental duties and constitutional values, urging a commitment to integrity and ethical conduct.

What is Mulya Pravah?

• Officially notified in 2019, Mulya Pravah aims to instil human values and professional ethics within higher education institutions.
• Its explicit objective is to cultivate value-based institutions by guiding individuals and institutions toward fostering profound respect for fundamental duties, constitutional values, and a strong connection with the country.

What is Mulya Pravah 2.0?

• Mulya Pravah 2.0, a revised guideline by the University Grants Commission (UGC), is designed to foster ethical practices and human values within higher education institutions.
• Its inception was prompted by revelations from a survey among human resource managers, uncovering unethical practices like favouritism, sexual harassment, and gender discrimination in various organisational processes.
• The primary objective of this guideline is to construct value-based institutions by nurturing a sense of respect for fundamental duties, and constitutional values, and fostering a connection to the nation.

Key Features of Mulya Pravah 2.0:

• Addressing Unethical Practices: Mulya Pravah 2.0 confronts the prevalent unethical practices identified in higher education institutions, as uncovered by a survey involving human resource managers.
  • These malpractices encompass favouritism, sexual harassment, gender discrimination, inconsistent discipline, lack of confidentiality, and unscrupulous dealings with vendors for personal gain.
  • While acknowledging that such issues may extend beyond higher education, this guideline serves as a commendable initiative toward fostering ethical conduct.
• Emphasis on Transparency: A pivotal aspect of Mulya Pravah 2.0 is its advocacy for absolute transparency in administration. Decision-making within higher education institutions is expected to be guided solely by institutional and public interest, free from biases.
  • The guideline stresses the elimination of discriminatory privileges and underscores the importance of penalizing corruption.
  • It urges the establishment of a conducive culture and work environment, aligning actions with the best interests of the institution.
• Guidelines Emphasize Upholding Values: Mulya Pravah 2.0 mandates that higher education institutions uphold values such as integrity, trusteeship, harmony, accountability, inclusiveness, commitment, respectfulness, belongingness, sustainability, constitutional values, and global citizenship.
  • This intervention is timely, considering the diminishing prevalence of these values. Officers in universities are entrusted with ensuring strict adherence to these values both in letter and spirit.
• Guidelines Remind Institutions to Act in the Best Interest: Mulya Pravah 2.0 serves as a reminder for stakeholders to act in the best interest of their institution, fostering a conducive culture and work environment for teaching, learning, and research while developing the potential of the institution.
  • It explicitly states that officers and staff must refrain from misappropriating financial and other resources.
  • Additionally, it calls for a refusal to accept gifts, favours, services, or other items from any entity that may compromise the impartial performance of duties.

What are the Challenges in the Effective Implementation of Mulya Pravah 2.0?

• Sincerity and Commitment of Higher Education Regulators: The mere issuance of guidelines may prove insufficient if higher education regulators lack sincere commitment to enforce the provisions of Mulya Pravah 2.0.
  • The UGC must demonstrate unwavering determination, setting a precedent by exhibiting zero tolerance for any form of corruption or ethical violations within the academic sphere.
• Institutional Resistance to Change: Established norms and practices within higher education institutions may resist the infusion of Mulya Pravah 2.0's principles, as institutional cultures can be deeply ingrained.
  • Overcoming institutional inertia requires proactive efforts by university administrators, faculty, and other stakeholders to embrace and implement the ethical guidelines.
• Lack of Monitoring Mechanisms: Effective implementation requires robust monitoring mechanisms to track and evaluate adherence to the guidelines at various levels.
  • The absence of a comprehensive monitoring framework may lead to laxity, allowing unethical practices to persist unchecked.
• Resistance from Internal Stakeholders: Faculty, staff, and student unions might resist the guidelines, perceiving them as an imposition on their autonomy or a threat to established practices.
  • Overcoming resistance necessitates effective communication, collaboration, and building consensus among all internal stakeholders.
• Balancing Transparency and Confidentiality: The guideline's emphasis on maintaining confidentiality might clash with the broader societal demand for transparency in higher education institutions.
  • Striking a delicate balance between the two is crucial to avoid potential conflicts and ensure the right to information is not compromised.
• Undefined Parameters and Ambiguities: Some aspects of Mulya Pravah 2.0, such as what constitutes a dignified manner for raising issues, lack clear definitions.
  • Ambiguities in the guideline could lead to misinterpretations, allowing room for manipulation and misuse.
• Legal and Regulatory Compliance: Ensuring that institutions adhere to the legal and regulatory framework while implementing Mulya Pravah 2.0 is essential.
  • Non-compliance or overlooking legal aspects may render the guideline ineffective or subject to legal challenges.
• Cultural and Regional Variations: Higher education institutions exhibit diverse cultural and regional variations, influencing the reception and interpretation of ethical guidelines.
  • Tailoring the implementation strategy to accommodate these variations is vital for the guidelines to resonate across different contexts.
• Inadequate Training and Awareness Programs: The success of Mulya Pravah 2.0 depends on the understanding and active participation of all stakeholders.
  • Insufficient training and awareness programs may result in a lack of clarity regarding the guidelines, reducing their impact.

What Steps Can Be Taken to Improve Governance in Higher Education Institutions (HEIs)?

• Addressing the Issue of Confidentiality: The guideline should advocate for institutions to promptly publish agendas, proceedings, and minutes of meetings held by their decision-making bodies, sub-committees, and standing committees.
  • Furthermore, institutions are encouraged to make their annual reports and audited accounts accessible to the public.
  • This proactive disclosure can act as a deterrent against malpractices and contribute significantly to rebuilding public trust in institutional operations.
• Addressing Teachers’ Associations: Recognizing the significant impact teachers have on students' character, personality, and careers, Mulya Pravah 2.0 emphasizes that teachers should serve as role models.
  • This involves exhibiting good conduct and maintaining high standards of dress, speech, and behavior for students to emulate.
  • While the guideline underscores the expectation for teachers to adhere to university rules and policies, it does not explicitly address the role or function of teachers' associations, which warrants attention for a comprehensive approach.
• Clarity on the Definition of 'Dignified Manner' for Unions and Support: Mulya Pravah 2.0 anticipates the support of staff and student unions in development activities while urging them to raise concerns in a dignified manner.
  • However, the guideline lacks a clear definition or explanation of what constitutes a 'dignified manner.'
  • This absence leaves room for potential misuse, allowing the provision to be wielded in ways that may threaten, silence, or undermine the collective voices of stakeholders.
  • A clear definition is crucial to avoid such misinterpretations and promote a healthy collaborative environment.

Conclusion

Mulya Pravah 2.0, introduced by the University Grants Commission, represents a commendable stride in instilling ethical values within higher education. Nonetheless, addressing its challenges necessitates inclusive discussions with all stakeholders. Effective implementation is imperative for realizing its potential to enhance the quality and sustainability of decisions within the educational sphere.