Last week, The Ministry of Health and Family Welfare released draft guidelines for the withdrawal of life support in terminally ill patients. They said this decision should be taken by the doctors, taking the patient’s overall health status and medical condition into account. In the draft, terminal illness has been defined as an irreversible or incurable condition from which death is inevitable in the foreseeable future.
Doctors had always taken clinical decisions in good faith. The patient’s relatives are explained and given all information, taken into confidence in a given case, and a decision is taken on merit in every single caseR V Asokan, National President of the Indian Medical Association (IMA)
Asokan said it is a misunderstanding of the situation alleging that inappropriate decisions have been taken or they have been prolonged by clinicians. He also highlighted that this move may put doctors under undue stress and expose them to legal scrutiny.
Active euthanasia or the act of intentionally causing the death of a terminally ill patient on voluntary request is illegal in India. In March 2018, The Supreme Court allowed passive euthanasia, which is death by withholding of life-saving treatment in cases of chronic terminal illness with no chances of survival or improvement.
The conditions to discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm by causing suffering and loss of dignity are as follows:
If the individual has been declared brainstem dead according to Transplantation of Human Organs and Tissues (THOA) Act of 1994, or if there is a medical prognosis that the patient’s disease condition is advanced and not likely to benefit from aggressive therapeutic interventions.
Patient / surrogate informed refuses to continue life support following prognostic awareness, and compliance with procedures prescribed by the Supreme Court.
Doctors should take a considered decision to not start life-supporting treatments (LSTs) such as mechanical ventilation, dialysis, surgical procedures, transfusions in a terminally ill patient that is unlikely to benefit the patient and is likely to lead to suffering and loss of dignity.
According to the legal principles outlined by the Supreme Court, “an adult patient capable of taking healthcare decisions may refuse LST even if it results in death”. In case a patient is incapable of taking decisions, proposals for foregoing life support would be made by consensus among a group of at least three physicians who form the Primary Medical Board (PMB).
“The PMB must explain the illness, the medical treatment available, alternative forms of treatment, and the consequences of remaining treated and untreated to fully inform the surrogate,” the draft states. A Secondary Medical Board of three physicians with one appointee of the district’s Chief Medical Officer (CMO) will have to validate the decision made by the PMB.
Asokan commented on the guidelines mentioning that the assumption that unnecessarily machines are being used and lives are prolonged is wrong because it exposes the doctors to legal scrutiny, he told news agency PTI. Asokan added such calls should be left to relatives, patients, and doctors based on science and situation.
Considering this scenario, the health ministry has asked for feedback and suggestions from all stakeholders on the draft by October 20, 2024.
(Input from various sources)
(Rehash/Dr. Shreya Dave/MSM)