The Supreme Court’s historic decision, legalising passive euthanasia and the right of individuals to prepare ‘living will’ or Advance Directives (AD) refusing futile or unnecessary medical treatment, is a groundbreaking development which recognises patient autonomy, says M.R. Rajagopal, End-of-Life Care and Palliative Medicine specialist.
The barriers to end-of-life care and palliative care in the country are multi-dimensional, ranging from the mindset of physicians who are trained to do everything possible to keep the heart beating; variable procedures in modern, technology-laden super speciality hospitals; and the misunderstanding amongst the public on how to allow natural death to take place.
“The SC judgement means that the directives I give in advance, when I have the competence for decision-making, that in the event of terminal illness I should not be isolated in an ICU or provided artificial ventilation, will now be binding on medical professionals. But the procedures that the court insists on, for legalising AD, should be made easy and accessible to common man,” Dr. Rajagopal says.
No criminal liability
The SC has thus legally validated an individual’s right to die with dignity and physicians no longer need to fear criminal liability for not proceeding with life-sustaining treatment for a terminally ill individual.
Creating public awareness of the concept is much more crucial, for they should be made to understand that the SC judgement is not about active ending of life. In that sense, the terminology, passive euthanasia, can be much misunderstood.
“Withholding or withdrawal of treatment is not euthanasia. The terminology, euthanasia, is thus flawed, ambiguous and outdated,” points out R.K. Mani, a Critical Care specialist based in Mathura and one of the members of End of Life Care in India Taskforce.
While lauding the Supreme Court judgement as a landmark one, one which uphold’s patient’s rights, Dr. Mani also feels that the implementation is likely to trump the good intent behind it.
“We are talking about death in Intensive Care Units (ICUs) which is a daily occurrence. The procedures now insisted on by the court just makes it harder for the common man to die with dignity. We need to set up a task force to examine the implementation of the judgement because safeguards insisted on by the court to prevent abuse should not thwart its implementation,” Dr. Mani says
Chances of misuse
“There may be some valid fears whether the Advance Directives can be misused by anyone. We will need to ensure that there is no room for abusing this provision. When we talk about the sanctity of life, we should also talk about a person’s right to choose natural death over artificial life support,” Dr. Rajagopal says.
