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.

In News:

The Convention on Biological Diversity (CBD), while historically overshadowed by climate change discussions, is now gaining increasing attention due to the growing recognition of the global biodiversity crisis. This evolving prominence highlights the need for urgent action to preserve ecosystems and halt biodiversity loss, which is intimately linked with the climate crisis.

Overview of the Convention on Biological Diversity (CBD)

• Origins and Objectives:
  • The CBD emerged from the 1992 Rio Earth Summit, alongside the UN Framework Convention on Climate Change (UNFCCC).
  • Main Goals:
  • Protect global biodiversity.
  • Restore ecosystems.
  • Ensure equitable distribution of the benefits derived from biological resources.
• COP16 and the Kunming-Montreal Framework:
  • The 16th Conference of Parties (COP16) marks the first meeting following the Kunming-Montreal Global Biodiversity Framework adopted at COP15 in 2022.
  • The framework sets out four key goals and 23 targets to be achieved by 2030, including:
  • Protect 30% of global lands and oceans by 2030.
  • Restore 30% of degraded ecosystems by 2030.

The Growing Convergence Between Climate Change and Biodiversity

• Interlinkages Between Climate Change and Biodiversity:
  • Mutual Impact:
  • Climate change accelerates biodiversity loss by altering habitats and threatening species.
  • In turn, ecosystem degradation contributes to climate change by releasing greenhouse gases (GHGs) from deforestation and soil degradation.
• Shared Drivers:
  • Both crises are driven by unsustainable human activities, including over-exploitation of natural resources, deforestation, over-consumption, and pollution.
• Increasing Synergy:
  • There is a growing realization of the need for integrated solutions that address both climate change and biodiversity loss simultaneously.
• Momentum for 30 x 30 Targets

• The 30 x 30 Commitment:
  • The 30 x 30 targets are central to the Kunming-Montreal Framework, which includes:
  • Conservation of 30% of the world's lands and oceans.
  • Restoration of 30% of degraded ecosystems.
  • These targets aim to ensure the preservation of biodiversity-rich areas and the restoration of degraded ecosystems globally by 2030.
• National Biodiversity Strategies and Action Plans (NBSAPs):
  • Countries are required to develop and submit their NBSAPs (akin to Nationally Determined Contributions (NDCs) for climate change).
  • As of now, only 32 countries have submitted their NBSAPs, with more expected during COP16.
• High Seas Treaty:
  • A crucial agreement for achieving 30 x 30 targets is the High Seas Treaty (also called Biodiversity Beyond National Jurisdictions (BBNJ)), which focuses on:
  • Establishing protected marine areas in biodiversity-rich regions beyond national jurisdictions.
  • Ensuring regulation of human activities in these areas.

Access and Benefit Sharing: The Case of Genetic Resources

• Genetic Resources and Their Exploitation:
  • The oceans, along with terrestrial ecosystems, harbor a wide variety of genetic resources that can be exploited for medical, commercial, and scientific purposes.
  • Advances in biotechnology and digital sequencing of genetic material have raised issues about the equitable sharing of benefits from these resources.
• Nagoya Protocol and Benefit Sharing:
  • The Nagoya Protocol (2010) set out guidelines for the access and fair sharing of benefits derived from genetic resources.
  • At COP16, discussions will center on how genetic sequences (used in products such as medicines, crops, etc.) can be used fairly, ensuring that indigenous communities, who may be the original custodians of these resources, benefit equitably.

Finance Mechanisms for Biodiversity Conservation

• Financial Targets:
  • One of the key goals of the Kunming-Montreal Framework is to mobilize $200 billion per year by 2030 for biodiversity conservation globally.
  • Developed countries are expected to contribute $20 billion annually to developing nations, increasing to $30 billion by 2030.
• Phasing Out Harmful Subsidies:
  • Countries are urged to eliminate perverse incentives that harm biodiversity, such as subsidies for:
  • Over-fishing.
  • Deforestation.
  • Fossil fuel consumption.
  • The goal is to repurpose such incentives to support sustainable practices and conservation efforts.
• New Financial Mechanisms:
  • COP16 discussions will also focus on creating innovative financial mechanisms, such as:
  • A biodiversity fund.
  • Biodiversity credits, similar to carbon credits, which would allow countries or organizations to offset their biodiversity loss by investing in conservation projects elsewhere.

Challenges and the Way Forward

• Implementation of 30 x 30 Targets:
  • The main challenge lies in translating ambitious goals into actionable plans at the national and local levels. Countries must not only submit action plans but also implement and monitor them effectively.
• Increased Global Cooperation:
  • Addressing biodiversity loss requires collaboration between countries, industries, and local communities to ensure that efforts are comprehensive and inclusive.
• Public Awareness and Engagement:
  • It is crucial to raise awareness about the importance of biodiversity conservation and the urgent need for collective action to mitigate the combined threats of biodiversity loss and climate change.

Conclusion: The Need for Urgent Action

The discussions at COP16 signal an important shift in how the world addresses biodiversity and its links to climate change. As countries continue to recognize the interconnectedness of these two crises, the outcome of the CBD negotiations could play a pivotal role in shaping global environmental policy. However, meeting the ambitious goals set forth by the Kunming-Montreal Framework requires strong political will, adequate financing, and effective global cooperation.