Medical community welcome 'living will' judgement but some also caution against misuse and pressured use

NEW DELHI: The Indian medical fraternity has largely welcomed the landmark Supreme Court judgement allowing people to write a living will or advanced directive for end-of-life care, saying that it will save millions of patients from unnecessary or inappropriate life-support offered by the hospitals.

Raj K Mani, a Mathura based critical-care expert, who has formed a professional group called End of Life Care in India Task-Force (ELICIT) said that the verdict has “restored the right of dying with dignity” for people in India.

“It’s a profound, landmark judgement which will define doctor-patient relationship and ensure the process of dying is extremely private as it should be,” he said.

“We see dilemma faced by families and doctors day in and out who struggle to decide on what to do in cases where patients are very critical and beyond recovery but are kept alive artificially. There was a legal void there on what to do in such cases—this verdict fills that gap,” he said.

Stanley Macaden, a palliative care expert in Bangalore said that it is a “right” judgement with a “wrong” terminology as it uses the word “euthanasia.”

“In a country where crores of families are pushed into poverty every year due to exorbitant costs paid towards critical care, it will help people to take informed decisions,” he said. “But I think at a time where most countries are preferring terms such as end-of-life care, the SC would have done better to refer to terms prescribed by the Indian Council for Medical Research on the matter.”

Some experts, however, expressed concerns on the implications of the decision as “terminal illness” can be a subjective term.

“There are many diseases where treatment is theoretically available but too expensive for families to pay—will they then consider withdrawing life support for their seriously ill kin purely for financial reasons?,” asked Sanjay Nagral, a surgeon at Jaslok hospital in Mumbai and a member of the Association Of Doctors for Ethical Healthcare.

 “Also, such patients might be mentally, emotionally pressured into writing a will, knowing that their family cannot afford the treatment.”

Rajesh Pande, Joint secretary of the Indian Society for Critical Care Medicine said that in a country like India where education level is low and there is a big rural-urban divide, it remains to be seen how many people will write “living wills.”

“We have been campaigning for passive euthanasia—but in this verdict it is not clear what happens in cases where patients have no medical will.  Even in an evolved society like USA, only 67 per cent people have living wills,” he said.