Medical facilities woefully inadequate, say Judges

On a day when the Supreme Court uttered powerful words that the State cannot deprive an individual the right to end life with dignity, two out of the five judges who authored the judgment did not miss out to question if the advance directive or living will actually benefit the masses given that a large segment is deprived of even basic medical care.

Justice DY Chandrachud in his separate but concurring opinion observed that an advance directive or living will is based on the hypothesis that medical care is available to citizens as only then can they choose to refuse treatment. "The stark reality in our society is that medical facilities are woefully inadequate. Primary medical care is a luxury in many places. Public hospitals are overwhelmed by the gap between the demand for medical care and its supply. Advance directives may have little significance to large segments of Indian society which are denied access to basic medical care."

His views were echoed by another judge on the bench, Justice AK Sikri who noted, "Right to health is a part of Article 21 of the Constitution. At the same time, it is also a harsh reality that everybody is not able to enjoy that right because of poverty, etc. Thus when citizens are not guaranteed the right to health, can they be denied right to die in dignity?"

He observed that a dreadful, painful death to an incapacitated terminally ill patient is an affront to human dignity. But it is also true that 90 per cent of intensive care unit in the country is located in the private heathcare sector. The judge quoted a study that revealed India's position at 67th out of 80 countries in the ranking of Quality of Death Index. India's spending on health of citizens is a pitiable 1.4 per cent of GDP and the 2017 National Health Policy promises no good result as by 2025, the health expenditure is projected to rise to 2.5 per cent of GDP. Justice Chandrachud also noted rising costs of medical care in urban areas threatens to ruin finances of a family whose member is struck by a terminal illness.

He observed, "In the absence of a social security net, universal medical coverage, and compulsory insurance, it is the family to which a patient turns to in distress….To them, advance directives may provide a measure of assurance when a crucial decision as to whether to prolong artificial support in an irreversible medical situation is to be taken." However, he recommended that advance directive needs periodic review and revision to ensure it is not utilised as a "subterfuge" for facilitating a succession to property.