In 2022 and 2023, I wrote blogs on the topic of Euthanasia, and the present government governments regulations. A few days back, the government issued a draft titled “ Guidelines for Withdrawal of Life Support on Terminally Ill Patients (Passive Euthanasia)”.
The draft stated ‘ A considered decision in a patient’s best interests, to stop or discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm in terms of causing suffering and loss of dignity.
As per the draft guidelines, the withdrawal of life support includes four conditions:
1 The individual must be declared brainstem dead as per THOA ( Transplantation of Human Organ Act).
2 Medical prognostication must indicate that the patient’s condition is advanced and unlikely to benefit from aggressive therapeutic interventions.
3 The patient or surrogate must document an informed refusal, following prognostic awareness, to continue life support.
4 There must be compliance with the procedures prescribed by the Supreme Court (SC).
The draft also states that ‘doctors should not consider the decision to not start a life supporting measure’ in a terminally-ill patient that is unlikely to harm in terms of suffering and loss of dignity.
“ A considered decision in a patient’s best interests, to not start a life supporting measure in a terminally ill patient, that is unlikely to benefit the patient and is likely to harm in terms of suffering and loss of dignity”, as per draft.
The draft further explains that in such a situation, three conditions on whether the individual Hs been declared brainstem dead, if there is a medical prognostication and considered opinion that patients disease condition is advanced, individual declared brainstem death as THOA, and patient/surrogate documented informed refusal, following prognostic awareness, to continue life support, have been mention in this draft.
The terminal illness in the draft guidelines 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 include’.
The draft mentions that the legal principles outlined by SC state an adult patient capable of taking healthcare decision may refuse Life Support Treatment (LST) even if it results in death, LST may be withheld or withdrawn lawfully under certain conditions from persons who no longer retain decision-making capacity, based on the fundamental right to Autonomy, Privacy and Dignity, Advanced Medical Directives (AMD) that meets specified requirements is a legally valid document.
The guidelines also states that for a patient without capacity, Foregoing of Life Support treatment (FLST) 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 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.
In India the Active Euthanasia is not allowed, this is an 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 patient. In 2018, the SC had allowed passive euthanasia. These guidelines are the first step towards passive euthanasia.
Passive euthanasia refers to the intentional withholding or withdrawal of medical treatment life-sustaining interventions, allowing a person to die naturally from their underlying condition. This can include stopping treatments like ventilators, feeding tubes, or medications that keep the patient alive. Unlike active euthanasia, which involves direct actions to cause death, passive euthanasia allows death to occur by not intervening in the natural progression of an illness.
Passive euthanasia is often considered in cases where the patient is suffering from a terminally illness, has little or no chance of recovery, or is in persistent vegetative state. Decisions for passive euthanasia are typically made based on the patient’s wishes, advance directives, or through family members and healthcare proxies when the patient can not make decision themselves. This practice raises ethical questions but is legal in many countries, under certain guidelines and conditions.
In my opinion this is the right step by the government for making passive euthanasia legal in the country. The government has invited feedback and suggestions by 20th October 2024.
Waiting for your feedback on this blog.
Anil Malik
Mumbai, India
30th September 2024.
Friends, I have crossed the milestone figure of writing 1550 blogs, with my last blog of 27th September.