Govt opposes ‘living will’: All you need to know about euthanasia, right to die with dignity

The government opposed the concept of a ‘living will’, or advance medical directive by patients for mercy killing, in the Supreme Court on Tuesday.

SC was hearing a plea by NGO Common Cause to declare ‘right to die with dignity’ as a fundamental right within the fold of right to live with dignity, which is guaranteed under Article 21 of the Constitution.

A five-judge constitution bench of the top court, headed by Chief Justice Dipak Misra, was hearing the case.

Here’s all you need to know about euthanasia and ‘living will’:

• Living will

The government said it was against permitting living will as ‘it could be enormously misused”.

A ‘living will’ is a concept where a patient can give consent that allows withdrawal of life support systems if the individual is reduced to a permanent vegetative state with no real chance of survival.

It is a type of advance directive that may be used by a person before incapacitation to outline a full range of treatment preferences or, most often, to reject treatment. A living can detail a person’s preferences for tube-feeding, artificial hydration, and pain medication when an individual cannot communicate his/her choices.

The US, UK, Germany and Netherlands have advance medical directive laws that allow people to create a ‘living will’.

• Active and passive euthanasia

Active euthanasia, the intentional act of causing the death of a patient in great suffering, is illegal in India. It entails deliberately causing the patient’s death through injections or overdose.

But passive euthanasia, the withdrawal of medical treatment with the deliberate intention to hasten a terminally ill patient’s death is “partially” allowed.

The patient, family, friends and legal guardians can’t take the decision on their own, but need a high court’s approval bill for stopping treatment .

• Euthanasia in law

The government told the court on Tuesday there was already a law on passive euthanasia and it had drafted a ‘management of patients with terminal illness-withdrawal of medical life support bill’.

The issue of euthanasia was first examined by the health ministry in consultation with the experts in 2006, based on the 196th Law Commission of India report. However, it was decided to not make any laws on euthanasia.

• Aruna Shanbaug case

In 2011, the Supreme Court, while hearing the case of Aruna Shanbaug, who was in a vegetative state for nearly 30 years, had legalised passive euthanasia partially.

A nurse at KEM Hospital in Mumbai, Shanbaug was in a vegetative state since 1973 after a brutal sodomisation and strangling with a dog-chain during a sexual assault. She died in 2015 while on a ventilator for several days after suffering from pneumonia.

SC gave patients living in a vegetative state the right to have treatment or food withdrawn, and laid down guidelines to process passive euthanasia in the case of incompetent patients. The guidelines include seeking a declaration from a high court, after getting clearance from a medical board and state government.

• Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill

In 2012, the union health ministry posted a draft of the Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill on its website and invited public reactions.

The Bill is popularly referred to as the Passive Euthanasia Bill although its draft did not use the emotive word “euthanasia” to skirt complications around the term, a health ministry official told HT last year. It says every advance medical directive (also called ‘living will’) or medical power of attorney executed by a person shall be taken into consideration in matter of withholding or withdrawing medical treatment but it shall not be binding on any medical practitioner.

The draft bill has a controversial clause that allows a minor aged above 16 to take an informed decision and express a desire to withhold or withdraw medical treatment and allow nature to take its own course.

 Medical experts on euthanasia

Doctors have a mixed reaction to legalising euthanasia. They say the government needs to take a careful approach before legalising passive euthanasia when the measures to prolong the life of the patient are withdrawn.

Most doctors, however, agree that euthanasia should be made legal in cases where there is no scope of a patient recovering. But many feel that India is not yet ready for a decision like this which requires a mix of sensitivity and maturity.

• Misuse of law

A major concern is the misuse of the law. If it is legal to passively allow or actively hasten death, what’s to say an aged parent won’t be hastened in favour of an inheritance, or a spouse have treatment withdrawn for the sake of a hefty insurance payout?

• Euthanasia in other countries

Euthanasia and physician-assisted suicide have been legal in The Netherlands and Belgium since 2001 and 2002. In the US, Switzerland and Germany, euthanasia is illegal but physician-assisted suicide is legal. Euthanasia remains illegal in the UK, France, Canada and Australia.

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