Life is very unpredictable, isn’t it? No one can tell what happens to you the next moment. There are many cases where a person hale and healthy in this moment will slip into coma or some state where the chances of recovery is minimal. This stage which is a thin line between life and death is very agonizing both to the patient and their family. In most of the cases, the patients are alive, only through vital processes like breathing, weak pulses, etc. who is not at all conscious which clearly show that the person is surviving only on life saving systems, but for them the person would be no more. This state is a very big burden on the middle and lower middle class, not to mention poor families because the charges of these lifesaving systems cost more than their monthly or probably annual salary. Having a close on in such a stage is already a trauma. This financial burden just adds to that and they will be in a helpless situation, without even a single ray of hope of recovery of the close one. Here was the dilemma between continuing the medical aid or not. It would be a waste of resources (including the financial resources of the family) and it would become a murder if the life support systems were withdrawn.
Thankfully, the Supreme Court came to the rescue of such people and recently gave its consent to passive euthanasia wherein terminally ill patients with no hopes of recovery can be let to die with dignity by withdrawing the life supporting system. It also recognized that the Right to Live with Dignity also includes ‘smoothening’ the process of death.
The Apex Court also laid down rules guiding the drafting of Advance Medical Directive (living will) and administering passive euthanasia both in the presence of a living will or its absence.
Here are a few details on how these Advance Medical Directives work and how passive euthanasia is administered.
Advance Medical Directive – Living Wills – Choice of Life or Death
Advance Medical Directive is a will that can be written by a healthy person who is fully capable of taking conscious decisions directing in case he/she falls terminally ill and slips into a stage where he/she is incapable of making decisions as to how long the treatment could continue and when is the treatment to be terminated.
Who can draft Advance Medical Directive?
- An adult full aware and fully capable of making conscious decisions and can comprehend and communicate the reason for drafting such a document.
- It should voluntary – not to be forced upon the person by anybody.
- It should be in writing and should clearly specify as to when the treatment has to be withdrawn or when the process of treatment causing slow death should be withdrawn.
What Should be included in Living Will?
- It should clearly mention under what circumstances the medical aid should be withdrawn.
- Instructions should be clear, unambiguos and with no space for any doubt.
- It should mention whether the patient can revoke the instructions and authority.
- It should mention that the person clearly understands the consequences of this will.
- The patient should clearly mention the name of a trustworthy close relative who, in case the person is incapable of taking decisions, can take decision regarding the withdrawal or continuation of the medical aid.
- If there are more than one Advance Directives, the most recent one will be considered.
Procedure for recording the Living Will
- The patient should sign the living will in the presence of two witnesses (preferably independent) and counter signed by the Jurisdictional Magistrate (First Class) (JMFC), so designated by the concerned district judge.
- The witnesses and the JMRC should testify that the statement was recorded voluntarily without any coercion by anyone.
- The JMRC should preserve one copy of the document with himself and send another copy of the same to the Jurisdictional court to preserve in the records.
- The JMRC should inform the immediate family members about the document and make them fully aware of the execution of the document.
- The JMRC should send one copy of the same to the local Municipal Corporation or Panchayat, whichever applicable. The authorities should nominate a competent official to be the custodian of the document.
- One copy of the document should be handed over to the family physician.
Execution of the document
- When the patient becomes terminally ill, the treating physician, when made aware of the document, should confirm the document from the JMRC before acting upon it.
- The document should be executed only after confirming that the patient is terminally ill, has no possibilities of recovery and/or is suffering from an incurable disease.
- The treating hospital must constitute a board of doctors consisting of the head of the treating department and three experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology of at least twenty years of experience who have to visit the patient in the presence of the close relative or guardian and look into the issue and decide whether the document can be executed or not.
- Then, the hospital medical board certifies that the document ought to be executed and the Jurisdictional collector should be informed about the proposal.
- The Jurisdictional Collector will constitute another board consisting of the Jurisdictional Medical Officer as the head and three expert doctors from the fields of general medicine, cardiology, neurology, nephrology, psychiatry, oncology.
- The chairman of the board constituted be the Collector should inform the JMFC about the execution of the document before withdrawing the medical treatment.
- The JMFC has to visit the patient and, after examining all aspects, shall authorize the execution of the decision of the medical board.
What if the Board refuses to permit the execution of the document?
There are various reasons why the board refuses to authorize the implementation of the document. Whatever be the reason, the treating hospital and the guardian or the close relative of the patient have all the rights to approach the high court if they are assured that their case is strong.
The concerned Chief Justice shall appoint a bench of justices to look into the matter and decide.
Is Euthanasia a legal murder and/or suicide?
Euthanasia, though in the onset, seems to be taking life away from a person (or oneself) which can either be termed a murder or suicide. But it is to be noted that the patients who are terminally ill and their relatives die every single day both due to pain and expenses. When there is no sign of recovery, this will be the ultimate resort of theirs to attain peace and salvation. However, old people applying for euthanasia where they are not at all terminally ill and are in a condition to take conscious decision and still want to ‘legally’ kill themselves, would amount to suicide, because they are yet to live. A piece of advice to them is to life their lives fully and as Alfred Lord Tennyson says, “Drink life to the lees”.
This should not be seen as a legal provision for murder or suicide. This is a means to uphold the dignity of life, extending it to dignity of death and with less pain.
Author: Ms. Nayana M R