More than six years since the Supreme Court’s landmark judgment on one of the most controversial and emotional issues of legal sanction to passive euthanasia, the Union Health Ministry has now released a draft guideline for withdrawal of life support in terminally ill patients. The draft guideline defines withdrawal of the life support as a considered decision in a patient's best interests, 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 in terms of causing suffering and loss of dignity. The draft guideline has clearly defined the terminal illness as an irreversible or incurable condition from which death is inevitable in the foreseeable future, including severe devastating traumatic brain injury which shows no recovery after 72 hours or more. Quite obviously, the Ministry has come out with the draft guidelines after considering the fact that many patients in the ICU are terminally ill, and not expected to benefit from life support treatments that include mechanical ventilation, vasopressors, dialysis, surgical procedures and transfusions, to name only a few. For such patients, life support treatments are non-beneficial and increase avoidable burdens and they increase emotional stress and economic hardship to the family and moral distress to professional caregivers. In a landmark judgment in March 2018, the Supreme Court had given legal sanction to passive euthanasia and execution of a 'living will' of persons suffering from chronic and terminal diseases and likely to go into a permanent vegetative state. Upholding a citizen's right to die with dignity, the apex court had allowed a person to draft a living will specifying that he or she should not be put on life support system if they slip into a situation of incurable coma in future, and thereby recognizing a patient's right to deny remaining alive on ventilator or an artificial medical support system.
Now, the Union Health Ministry has come out with the draft guidelines on the issue which is a welcome step because just as the human beings have the right to life, they also have the right to die with dignity. But, there are fears of misuse of the law, particularly by the relatives of a patient for usurping his or her properties and other benefits. Suppose a person meets with an accident or is bedridden, there will be people trying to usurp his or her property as soon as possible. In a country notorious for property disputes, such fears are not out of place. The way things work in the country, it can be misused. By allowing euthanasia and, at the same time, spelling out strict guidelines on how it is permissible, the Supreme Court had walked the proverbial extra mile in recognizing the exact interpretation of 'right to live with human dignity' mentioned in Article 21 of the Indian Constitution. Now, it is the responsibility of the Health Ministry to frame strict guidelines to prevent any misuse of the law. To address the issue, the Ministry has come out with a two-tier medical screening system. As per the guidelines, a Primary Medical Board constituted by the hospitals for each case, consisting of a primary physician and at least two subject experts with a minimum of five years of experience, and a Secondary Medical Board constituted by the hospital with one registered medical practitioner nominated by the chief medical officer and at least two subject experts with minimum of five years of experience will have the responsibility to look into such matters. Of course, the Health Ministry’s initiative is welcome as every human being has the right to die with dignity. But, the Ministry should ensure that the law is not misused by the people for their self-interest.
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