Health Ministry unveils updated draft guidelines for passive euthanasia
- In Reports
- 09:09 PM, Sep 28, 2024
- Myind Staff
According to draft guidelines from the Union Health Ministry, doctors are advised to make a "considered decision" regarding the withdrawal of life support for terminally ill patients based on specific criteria, including a documented informed refusal from the patient or their family.
The guidelines establish four conditions for passive euthanasia, aimed at ensuring the decision serves the patient's best interests when ongoing life support is deemed unlikely to benefit or could cause suffering and a loss of dignity. These conditions include: the individual being declared brainstem dead, a medical assessment confirming that the patient's advanced condition is not likely to improve with aggressive treatment, documented informed refusal by the patient or their surrogate after understanding the prognosis, and adherence to procedures set forth by the Supreme Court.
The 'Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients' indicate that doctors should carefully consider not initiating life-support measures for patients who are terminally ill if such measures are unlikely to benefit them and may result in suffering and a loss of dignity. To make this decision, three conditions must be assessed: whether the individual has been declared brainstem dead, if a medical assessment confirms that the patient’s condition is advanced and unlikely to improve with aggressive treatment, and whether there is a documented informed refusal from the patient or their surrogate, based on an understanding of the prognosis.
The Union Ministry is seeking feedback from stakeholders on these draft guidelines by October 20. However, the response from the medical community has been mixed, with the Indian Medical Association’s national president, Dr. R.V. Asokan, expressing concerns that the guidelines could expose doctors to legal scrutiny and create additional stress for them.
Dr. Asokan emphasised that clinical decisions have always been made by doctors in good faith, with patients' relatives being fully informed and involved in the process. He expressed concern that framing these decisions in rigid guidelines and implying that inappropriate or unnecessary prolongation of life has occurred misrepresents the reality.
He argued that the assumption that machines are used excessively to prolong life is incorrect and that such perceptions expose doctors to legal scrutiny. Furthermore, he noted that reducing the doctor-patient relationship to strict documentation undermines its essence and adds undue stress to medical professionals.
Dr. Asokan asserted that decisions should be guided by medical science and the specific circumstances of each case, allowing more discretion for patients, their families, and doctors. The Indian Medical Association plans to review the draft guidelines and provide feedback advocating for their revision.
The draft guidelines define terminal illness as an irreversible or incurable condition from which death is expected in the foreseeable future. This includes severe traumatic brain injuries that show no signs of recovery after 72 hours or more.
The document notes that many patients in the ICU are terminally ill and unlikely to benefit from life-sustaining treatments (LST), which encompass a range of interventions such as mechanical ventilation, vasopressors, dialysis, surgical procedures, transfusions, parenteral nutrition, and Extracorporeal Membrane Oxygenation.
In these situations, the guidelines state that LST may be considered non-beneficial, leading to unnecessary suffering and burdens for patients, along with emotional stress and financial strain on families and moral distress for healthcare providers. The withdrawal of LST in such cases is recognised as a standard practice in ICUs worldwide and is supported by various legal and ethical frameworks. The guidelines also suggest that similar considerations apply when deciding whether to initiate life support treatments for individuals.
The draft guidelines advocate for a careful decision regarding the withholding of cardiopulmonary resuscitation (CPR) in cases of anticipated cardiac arrest when there is no realistic chance of survival or meaningful recovery.
It emphasises that according to legal principles established by the Supreme Court, an adult patient who is capable of making healthcare decisions has the right to refuse life-sustaining treatments (LST), even if this leads to death.
Moreover, the guidelines state that LST can be legally withheld or withdrawn from individuals who have lost decision-making capacity, based on the fundamental rights to autonomy, privacy, and dignity. An Advance Medical Directive (AMD) that fulfills specified criteria is recognised as a valid legal document. An AMD is a written declaration made by a person with decision-making capacity that outlines their preferences for medical treatment or non-treatment in the event they lose that capacity.
For patients lacking decision-making capacity, proposals to forego life support should be reached by consensus among a group of at least three physicians, referred to as the Primary Medical Board (PMB). The PMB is responsible for thoroughly explaining the patient's illness, the available medical treatments, alternative options, and the potential consequences of both continuing and discontinuing treatment to ensure that the surrogate decision-maker is fully informed.
Additionally, a Secondary Medical Board, consisting of three physicians and one member appointed by the Chief Medical Officer of the district, must validate the PMB's decision.
The draft document also clarifies that active euthanasia—defined as the intentional act of ending the life of a terminally ill patient at their voluntary request through direct intervention by a doctor for the patient's benefit—is illegal in India.
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