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LUCID MAINS CURRENT AFFAIRS 2018

  1. EUTHANASIA
  • WHAT IS EUTHANASIA:
  • Euthanasia is defined as the, act or practice of painlessly putting to death or withdrawing treatment from a person suffering an incurable disease. Euthanasia is intentionally killing another person to relieve his or her suffering. 
  • Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Euthanasia is also classified into active and passive Euthanasia.
  • This issue came to limelight in India during Aruna Shahbaug case.
  • EUTHANASIA IN INDIA
  • Supreme Court upheld that the fundamental right to a “meaningful existence” which includes a person’s choice to die without suffering.
  • Since March 2018, passive euthanasiais legal in India under strict guidelines. Patients must consent through a living will or advance directive, and must be either terminally ill or in a vegetative state.
  • the Supreme Court of India legalized passive euthanasia by means of withdrawal of life support or discontinuation of life-preserving medical treatment so that a person with a terminal illness is allowed to die in the natural course
  • Active euthanasia including the administration of lethal compounds for the purpose of ending life, is still illegal in India.
  • SC GUIDELINES ON PASSIVE EUTHANASIA
  • ADVANCE MEDICAL DIRECTIVE

They are instruments through which a person express their wishes at a time she is not capable of making an informed decision of how medical treatment should proceed and how long it should continue, when she is not in a position to make an informed decision by reason of being unconscious or in a coma.

  • WHO CAN DRAW UP A LIVING WILL/ ADVANCE MEDICAL DIRECTIVE
    • An adult who is of a sound and healthy mind and in a position to communicate.
    • It must be voluntary
    • It should be in writing..
  • WHAT SHOULD IT CONTAIN
  • Instructions must be absolutely clear and unambiguous.
  • It should clearly indicate the decision relating to the circumstances in which medical treatment can be withdrawn.
  • It should mention whether the patient may revoke the instructions/authority at any time
  • It should specify the name of a guardian or close relative who, in the event of the patient becoming incapable of taking decision at the relevant time, will be authorized to give consent to refuse or withdraw medical treatment.

HOW SHOULD THE “LIVING WILL” BE RECORDED AND PRESERVED

  • It should be signed by the patient in the presence of two witnesses, preferably independent, and countersigned by a jurisdictional judicial magistrate, first class (JMFC), so designated by the concerned district judge.
  • The witnesses and the jurisdictional JMFC have to record their satisfaction that the document has been executed voluntarily and without any coercion or inducement or compulsion.
  • The JMFC has to preserve one copy and forward one copy of the document to the registry of the jurisdictional district court for being preserved. The JMFC has to inform the immediate family members of the patient and make them aware.
  • A copy has to be handed over to the municipal corporation or municipality or panchayat.

WHEN AND BY WHOM CAN IT BE IMPLEMENTED

  • The living will should be implemented only after being fully satisfied that the patient is terminally ill and the illness is incurable
  • The hospital has to constitute a medical Board consisting of the head of the treating department, the board have to visit the patient in the presence of his guardian/close relative and form an opinion to certify, or not certify, the instructions in the living will. This decision shall be regarded as a preliminary opinion.
  • After the hospital medical board certifies that the instructions contained in the advance directive ought to be carried out, the hospital has to inform the jurisdictional collector about the proposal.
  • The collector shall constitute another medical board comprising the chief district medical officer as the chairman
  • The chairman of the medical board nominated by the Collector has to convey the decision of the board to the jurisdictional JMFC before withdrawing the medical treatment administered to the patient. The JMFC shall authorize the implementation of the decision of the Board.
  • If permission is refused by the Medical Board, it would be open to the executor or his family members or even the treating doctor or the hospital staff to approach HC.
  • IN CASE OF NO ADVANCE DIRECTIVE

When a patient is terminally ill which is incurable, the hospital shall constitute a Medical Board which shall discuss with the family members and they could give the consent to proceed as said above.

  • PRACTICAL ISSUES OF THE JUDGMENT
  • Major hurdles might be posed by religious communities.
  • Morally and ethically, no doctor would want his patient to die on his watch. Thus this may create a difficult time for doctors involved.
  • If the patient is too ill to decide then the decision makers will be medical board and family members not the patient. Patient’s desire may not be taken into account.
  • Probability of its misuse — whether it is demanded for property, money, or because of animosity among family members — is very high.
  • WHAT NEEDS TO DONE
  • Promoting palliative care policies for elderly, poor and terminally ill patients who are most likely to opt for euthanasia.
  • National Health Protection Scheme is an answer to quality healthcare for poor managing serious terminal diseases.
  • Medical attorney and third party monitoring of “living will” so that it may not be manipulated.
  • The 241st report of the Law Commission states that passive euthanasia should be allowed with certain safeguards. The implementation of the recommendation of the commission.
  • Seminars and talks to remove the social stigma around the concept of euthanasia.
  • CONCLUSION

India does not have a comprehensive law on End of Life decision-making. The Supreme Court judgment is one step forward in handing control over to the individual. As a society we need to normalize death and to remove the taboo around discussing it. All doctors need to be aware of the basic principles of palliative care so that we can offer care when cure is no longer possible.