Supreme Court of India has upheld the fundamental right to die without suffering.
Medical fraternity has few practical dilemmas in applying passive euthanasia.
What is Euthanasia?
Euthanasia is a painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma, it is also known as Mercy killing or assisted suicide.
There are two different types of euthanasia which are passive and active euthanasia.
In active euthanasia, medical professionals, or a relevant authority, deliberately act upon a patient’s desire (such as giving an injection or medication) to cause the patient to die.
In passive euthanasia, the patient dies because the mechanism that keeps the patient alive is removed (life-support machines, feeding tube, a life-extending operation, and drugs).
What is the decision of the SC on passive euthanasia?
Supreme Court recently upheld that the fundamental right to a “meaningful existence” which includes a person’s choice to die without suffering.
It has permitted a ‘living will’ by patients, authorising the withdrawal of medical support if they slip into medically irretrievable conditions such as irreversible coma.
This judgement made passive euthanasia legal, and is favourable to patients who will now be able to avoid needless medical interventions.
The decision will also save a lot of money and agony for patients and their families, and prevent unnecessary treatments for the terminally ill.
What are the practical dilemmas with the living wills?
Morally and ethically, both euthanasia processes are difficult for doctors as no doctor likes to have a patient die under his/her care.
Even in the presence of a living will, and when one is honour-bound to respect the patient’s wishes, there are many questions and doubts.
For instance, the patient may have been coerced to write the will, sometimes a living will written at a certain juncture of a person’s life may not be applicable after a period of time when circumstances may have changed.
Without a fool proof system, doctors cannot give up on a patient, however desperate the circumstances.
Even with the legalisation of euthanasia, the “choice” to die may sometimes not be the final prerogative of the patient.
If the patient is too ill to decide on the will to live, then decision-makers possibly will be the medical team and the patients’ relatives, not the patient.
What measures needs to be taken to resolve the dilemmas?
Palliative care - Control over the manner and timing of a person’s death has not been and should not be a goal of medicine.
India needs improved access to high-quality healthcare for the terminally ill so that they go in peace, whenever they do.
This is referred to as palliative care right from the time an illness is diagnosed till the end of life.
Medical Attorney - The Supreme Court decision on a living will from a patient quells misgivings from the family and there are chances of criminal action against doctors.
Thus a living will makes sense when coupled with a medical power of attorney and independent third party monitoring.
This will allow for a middle way considering all the interests like the right of the patient, the state’s interest in human life, and the interest of the patient’s family.
