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Wednesday, Nov 20, 2019

Doctors say passive euthanasia a tough call for families but will improve end-of-life care

The Supreme Court judgment to allow passive euthanasia will give hospitals and doctors the much-needed legal support, doctors believe.

india Updated: Mar 09, 2018 23:29 IST
Anonna Dutt and Sadguru Pandit
Anonna Dutt and Sadguru Pandit
Hindustan Times, New Delhi
Former nurse Aruna Shanbaug lay in a vegetative state for 42 years at KEM Hospital's room number 4.
Former nurse Aruna Shanbaug lay in a vegetative state for 42 years at KEM Hospital's room number 4. (Kunal Patil/HT File Photo)

The Supreme Court in a landmark judgment on Friday allowed passive euthanasia and recognised “living will” or an “advance medical directive”, which lets patients decide whether they would like to withdraw life support if they have terminal illness. Here’s how doctors view the nuances and practical aspects of the euthanasia debate.

“Making a decision like this is extremely difficult for the family, especially when the patient is not conscious, because they have to consider what the patient would want. The advance directive gives their thoughts a direction,” said Dr Smitha Deshpande, head of the department of psychiatry at Dr Ram Manohar Lohia hospital.

Welcoming the judgment, Dr Anupam Sibal, group medical director, Apollo Hospitals Group, said every citizen should enjoy this right.

“This judgement will allow people to make a decision well in advance without any pressure, by weighing the pros and the cons. Most developed countries have provisions for a living will,” he said .

The term passive euthanasia is a misnomer, said Dr Sushma Bhatnagar, head of the palliative care department of the All India Institute of Medical Sciences (AIIMS).

“When we say euthanasia, people think that we are assisting people in dying. What it actually means is not performing procedures to prolong the life of patients we know will die soon. We do not do anything to hasten death,” she said. “What we focus on is good palliative and end-of-life care.”

The legal standing

Many public hospitals discuss realistic outcomes to help families choose whether they want to provide life-support to terminally ill patients with no hope of surviving. “You don’t see people living on ventilators for years at most public hospitals. There is a huge shortage of resources, especially ventilator beds, and each bed can be used to save many other lives,” said a doctor from Safdarjung hospital requesting anonymity.

The Supreme Court judgment will give hospitals and doctors the much-needed legal support. “Most patients in public hospitals support the decision not to use life-support systems when we explain the prognosis. But private hospitals face the threat of legal action and need some legal standing before even discussing such as step,” said Dr Bhatnagar.

On average, 5-10% of the ventilators and life-support systems of hospitals treat patients for an average of one to two months even after multiple clinical judgments show no signs of recovery.

The guilt

Even when the outcome is known and death is inevitable, it’s a tough call for not just the family but also the doctors. Having an advanced directive helps both the family and the doctors accept the decision without prolonged guilt.

“It becomes a moral battle for the doctors and the families. It was first in the case of Aruna Shanbaug that we actually started discussing the pros and cons of passive euthanasia,” said Dr Avinash Supe, dean of KEM Hospital where Shanbaug, a nurse spent over 42 years in a vegetative state following assault and rape in the hospital.

“As for doctors, it is very difficult to let a life go because they have been trained to save every life, so letting it go is very difficult. So, the directive will help the doctor in understanding that it was the patient’s wish,” said Dr Deshpande.

The judgment concurred, saying, “The primacy of the right of an individual in this regard has to be kept on a high pedestal.”