Draft Guidelines on Passive Euthanasia

Syllabus: GS2/Polity/Health

Context

• The Ministry of Health and Family Welfare released draft guidelines for the withdrawal of life support in terminally ill patients.

Euthanasia

• Euthanasia is the act of deliberately ending a person’s life to eliminate pain or suffering
  • Ethicists differentiate between active and passive euthanasia.
• Passive euthanasia entails the deliberate decision to withhold or withdraw medical interventions, like life support, with the aim of permitting a person’s natural death.
  • Active Euthanasia is the intentional act of killing a terminally ill patient on voluntary request, by the direct intervention of a doctor for the purpose of the good of the patient. It is illegal in India.

Draft Guidelines

• Definition of The Terminal Illness: It has been defined as an irreversible or incurable condition from which death is inevitable in the foreseeable future.
  • Severe devastating traumatic brain injury which shows no recovery after 72 hours or more is also included.
• The withdrawal of life support can be done under the four conditions: 
  • The individual must be declared brain stem dead as per the Transplantation of Human Organs (THOA) Act.
  • Medical prognostication must indicate that the patient’s condition is advanced and unlikely to benefit from aggressive therapeutic interventions.
  • The patient or surrogate must document an informed refusal, following prognostic awareness, to continue life support.
  • There must be compliance with procedures prescribed by the Supreme Court.
• Legal Principles: The legal principles outlined by the Supreme Court state an adult patient capable of taking healthcare decisions may refuse LST even if it results in death.
  • LST may be withheld or withdrawn lawfully under certain conditions from persons who no longer retain decision-making capacity, based on the fundamental right to Autonomy, Privacy and Dignity.
  • Advance Medical Directives (AMD) that meets specified requirements is a legally valid document.
• Mechanism: Proposals should be made by consensus among a group of at least 3 physicians who form the Primary Medical Board (PMB).
  • The PMB must explain the illness, the medical treatment available, alternative forms of treatment, and the consequences of remaining treated and untreated to fully inform the surrogate.
  • A Secondary Medical Board (SMB) of 3 physicians with one appointee by the Chief Medical Officer (CMO) of the district must validate the decision by the PMB.
  • Clinical Ethics Committee: Constituted by hospitals for audit, oversight, & conflict resolution.

Legal Stance

• The Supreme Court had in 2018 legalised passive euthanasia, contingent upon the person having a “living will”.
  • SC held that the ‘right to die with dignity’ forms a part of the right to life under Article 21 of the Constitution of India. 
  • A living will is a written document that specifies the actions to be taken if the person is unable to make their own medical decisions in the future. 
  • Goa is the first state that has formalised, to some extent, the implementation of directives issued by the Supreme Court.

Source: IE