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The draft guidelines lay out four conditions under which life support can be discontinued when it is no longer likely to benefit the patient or may cause suffering and a loss of dignity (Photo: Shutterstock)
The government’s new draft guidelines for passive euthanasia have not gone well with all clinicians. The head of a top medical body in the country says the move may put doctors under undue stress and expose them to legal scrutiny.
The Ministry of Health and Family Welfare last week released draft guidelines for the withdrawal of life support in terminally ill patients. They state that such a decision should be a ‘considered’ one and taken by the doctors, taking the patient’s overall health status and medical condition into account.
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In the draft, terminal illness has been defined as an irreversible or incurable condition from which death is inevitable in the foreseeable future.
Responding to the guidelines, R V Asokan, National President of the Indian Medical Association (IMA), said doctors had always taken such clinical decisions in good faith.
“The patient’s relatives are explained and given all information, taken into confidence in a given case, and a decision is taken on merit in every single case,” he said.
Asokan said by putting it down in guidelines and alleging that inappropriate decisions have been taken or they have been prolonged is a misunderstanding of the situation.
While active euthanasia or the act of intentionally causing the death of a terminally ill patient on voluntary request is illegal in India, the Supreme Court in March 2018 allowed passive euthanasia, which is death by withholding of life-saving treatment in cases of chronic terminal illness with no chances of survival or improvement.
Conditions for ending life support
The draft guidelines lay out four conditions to stop or discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm by causing suffering and loss of dignity.
These conditions include if the individual has been declared brainstem dead according to Transplantation of Human Organs and Tissues (THOA) Act of 1994, or if there is a medical prognosis that the patient’s disease condition is advanced and not likely to benefit from aggressive therapeutic interventions.
Other conditions include patient/surrogate documented informed refusal to continue life support following prognostic awareness, and compliance with procedures prescribed by the Supreme Court.
The draft guidelines also state that doctors should take a considered decision to not start life-supporting treatments (LSTs) such as mechanical ventilation, dialysis, surgical procedures, transfusions in a terminally ill patient that is unlikely to benefit the patient and is likely to lead to suffering and loss of dignity.
Commenting on the conditions laid down in the draft guidelines, Asokan said the perception and assumption that unnecessarily machines are being used and lives are prolonged is wrong. “It exposes the doctors to legal scrutiny,” he told news agency PTI.
Asokan added such calls should be left to relatives, patients, and doctors based on science and situation.
The draft guidelines also state that according to the legal principles outlined by the Supreme Court, “an adult patient capable of taking healthcare decisions may refuse LST even if it results in death”, the draft states.
In case of a patient incapable of taking decisions, proposals for foregoing life support would be made by consensus among a group of at least three physicians who form the Primary Medical Board (PMB).
“The PMB must explain the illness, the medical treatment available, alternative forms of treatment, and the consequences of remaining treated and untreated to fully inform the surrogate,” the draft states.
A Secondary Medical Board of three physicians with one appointee of the district’s Chief Medical Officer (CMO) will have to validate the decision made by the PMB. The health ministry has asked for feedback and suggestions from all stakeholders on the draft by October 20, 2024.
(With inputs from PTI)
First Published: Sep 30 2024 | 2:12 PM IST
