What is Living Will? What is the Medical Treatment of Terminally Ill? (Important)

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With centre informing Supreme Court for vetting a draft law to permit “passive euthanasia” - The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill but center is against people making “Living Wills” .

Forms of Euthanasia

What is Living Will?

  • Living wills allow direction that to not be put on life support in case of terminal illness.
  • Also termed as “advance medical directive”
  • The “medical treatment” refers to a life sustaining procedure so that death can be delayed.
  • The current draft considers the concept of Living Will or medical power-of-attorney void, but the Supreme Court found merit in the concept, paving the way for further discussion.

    What Does the Proposed Bill Say?

  • The draft Bill was released by the Health Ministry in 2016, based on the Law Commission of India՚s Report No. 241 (August 2012) .
  • Allows patient faced with terminal illness to decide whether he or she wishes to continue medical treatment in the form of life support or medication- “competent person” aged 16 or more can decide, with the consent of spouse or parents.
  • The medical practitioner is supposed to inform the patient of all treatment options, and can provide palliative care to make the end of life less painful.
  • When a patient cannot make a competent decision on continuing or withdrawing treatment (in a coma, or mentally challenged, or too ill to understand the consequences of treatment options) , the Bill allows a doctor, hospital or relative to approach a court to withhold treatment.
  • The court appointed panel would dispose of the matter in a month however, doctors are afraid that legal problems will delay the process.

What is Difference between Active and Passive Euthanasia?

  • In Aruna Ramchandra Shanbaug vs Union of India & Ors (March 7,2011) the Supreme Court distinguished between “active” and “passive” euthanasia:
  • “Active euthanasia entails the use of lethal substances or forces to kill a person, e. g. a lethal injection whereas passive euthanasia entails withholding of medical treatment for continuance of life, e. g. withholding of antibiotics where without giving it a patient is likely to die.”

History of Euthanasia in India

  • Euthanasia was examined in 2006, based on the 196th Report of the Law Commission- decided not to formulate a law.
  • Without legal framework, in Aruna Shanbaug case, Supreme Court permitted passive euthanasia.
  • The 2012 Law Commission Report recommended legislation on passive euthanasia and drew up a draft Bill - The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill - but warned that a Living Will may be misused.

End of Life Care in India Task Force (ELICIT)

  • An umbrella group called End of Life Care in India Task Force (ELICIT) drafted an alternative Bill on legalizing Living Wills.
  • In 2016, ELICIT came out with its “Mathura Declaration” , emphasizing the need to discuss “end-of-life care” in India.

Need for Legalization and Bill

  • Despite the 2011 judgment, hospitals refrain from pulling the plug, fearing medico-legal consequences.
  • With a Living Bill law, doctors are expected to be forthcoming in counselling families, and hospitals can be expected to have a uniform policy with regard to such cases.

What is “End-Of-Life Care” ?

  • Holistic approach to relieve a patient from suffering- may or may not be leading to immediate death- for example- end-stage cancer patients have only months to live, but require pain management.
  • Passive euthanasia is removal of life support with intent to end life, and thereby suffering, of vegetative or terminally ill patients.
  • Globally, medical practitioners have moved from ‘passive euthanasia’ to ‘end-of-life care’ - Both allow removal of life support to permit natural death.

What is International Consensus on Living Wills?

  • Australia allows “advance directive” for deciding future treatment especially if diseased is incompetent to make a decision then.
  • The Patient Self Determination Act gives US citizens the right to make personal healthcare decisions- recognises advance directives or living wills; the Common Cause petition is on the lines of the US Act, identifying the right to dignified death.
  • Euthanasia, in varying forms, is permitted in Belgium, Canada, and Sweden.

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