Activists seek simpler norms for ‘passive euthanasia’, living wills
The Indian Society of Critical Care has proposed a two-tier system to allow decisions to be jointly taken between authorised relative of the patient and the treating team of ‘three’ senior doctors.
The Indian Society of Critical Care (ISCC), one of the largest bodies of health care professionals in India, has recommended simplifying the procedure laid out by the Supreme Court (SC) on ‘passive euthanasia’ and living wills, stating that the current procedure is long-drawn and bureaucratic.
‘Passive euthanasia’ refers to the withdrawal of medical treatment with the intention to hasten a terminally ill patient’s death. A living will, also known as advanced directive, refers to a situation where the patient gives consent for withdrawal of life support in the event that he or she is reduced to a permanent vegetative state with no real chance of survival.
On March 9, 2018, SC passed an order legalising ‘passive euthanasia’ and the creation of living wills.However, the ISCC has stated that the procedure is “non-implementable” as doctors require clearances from various committees, which can take up to a month.
In a statement released last, SC recommended that a hospital-level committee, along with the patient’s family, should be allowed to make decisions regarding withdrawal of life-supporting treatments.
“We are proposing a committee similar to one that takes decisions about organ transplants at the hospital level,” said Dr Yatin Mehta, president, ISCC. “We welcome the SC’s judgment but the procedure it has listed is not feasible. It will add to the agony of the family of and will add to the mounting expenses till the decision is made by all the entities.”
ISCC has proposed a two-tier system to allow decisions to be jointly taken between authorised relative of the patient and the treating team of ‘three’ senior doctors.
Doctors have said that in the six months since the SC order, not many had created living wills. Roop Gurasahani, a neurologist at PD Hinduja and Research Centre, who is part of the group advocating for living wills, said “The judgment has not translated into anything workable because the procedure is too complicated.”
Other medical experts, alongside groups such as Indian Association of Palliative Care (IAPC), have also voiced their support for changes in the procedures. “We would also like to point out serious practical difficulties with the implementation of the procedure laid down by the Supreme Court,” said IAPC last month.
Mary Ann Muckaden, president, IAPC added that a hospital-level ethics committee should be allowed to make the decision in case there is a difference of opinion between the treating doctors. “Ethics committees have experts such as lawyers and social activists. Such cases could be referred to it, so a decision is reached in two to three days,” she said.
Meanwhile, there are those that have said that since it is a matter of human life, the procedure should be made stringent to prevent its misuse. Vipul Mudgal, director of Delhi-based non-governmental organisation Common Cause, whose public interest litigation in 2005 led to the legalisation of ‘passive euthanasia’ and living wills, said he holds no grudge against the procedure outlined by the court.
“It is matter relating to life and death. SC was clearly concerned about its misuse which is why it is so careful in its order and has multiple levels of checks. The court has given the order as there is a legislative vacuum on the issue,” said Mudgal.