With Haryana allowing terminally-ill patients to exercise their ‘right to die with dignity’, Ajay Sura lists the process in making the choice of giving up on life.
Patients in Haryana can exercise their “right to die with dignity” in case of any severe medical condition and no hope of recovery, as the health department has issued guidelines to all civil surgeons of the state.
In January 2023, the
Supreme Court
(SC) had recognised the right to die with dignity, making it easier for terminallyill patients to cease treatment.
“It is informed that the SC in the case titled as Common Cause versus Union of India, has laid down ‘Advance Medical Directive’ regarding the ‘right of a person to die with dignity’; which would serve as a fruitful means for making decision, when a person is faced with a medical condition with no hope of recovery and is continued on life support system/medicines, life support system may be withdrawn,” according to a communication sent by the health department to all civil surgeons of the state.
The letter — issued by director general health services a few months back — has directed the civil surgeons to circulate a copy to all doctors under their jurisdiction for information and necessary action. It means any person willing to exercise ‘right to die with dignity’ can do the same and the civil surgeon concerned can act in reference to this letter, if the persons seeking to exercise such right fulfils all the conditions mentioned by the apex court in its decision. The letter also contained the guidelines fixed by the Supreme Court.
Procedure Must Be Voluntarily Executed
➤ An informed consent given without any undue influence or constraint
➤ It shall be in writing clearly stating as to when medical treatment may be withdrawn or no specific medical treatment be given which will only have the effect of delaying the process of death that may otherwise cause him/her pain, anguish and suffering and further put him/her in a state of indignity
Document For ‘Death With Dignity’ Must Be Clear
➤ It should clearly indicate the decision relating to the circumstances in which withholding, or withdrawal of medical treatment can be resorted to
➤ It should be in specific terms and the instructions must be clear and unambiguous
➤ It should mention the executor may revoke the instructions/authority at any time
➤ It should specify the name of a guardian(s) or close relative(s) who, in the event of the executor becoming incapable of taking decision at the relevant time, will be authorised to give consent to refuse or withdraw medical treatment in a manner consistent with the advance directive.
In Case Of Two Documents
➤ In the event there is more than one valid advance directive, none of which has been revoked, the most recently signed advance directive will be considered as the last expression of the patient’s wishes.
What Is The Procedure
➤ The document should be signed by the executor in the presence of two attesting witnesses, preferably independent, and attested before a notary or gazetted officer
➤ The witnesses and the notary or gazetted officer shall record their satisfaction that the document has been executed voluntarily and without any coercion or inducement or compulsion and with full understanding of all the relevant information and consequences
➤ A copy shall be handed over to the competent officer of the local government or the municipal corporation or municipality or panchayat, as the case may be. The authorities shall nominate a competent official who shall be the custodian of the said document.
Who Can Give Effect To The Document
➤ In the event the executor becomes terminally ill and is undergoing prolonged medical treatment with no hope of recovery and cure of the ailment, and does not have decisionmaking capacity, the treating physician, when made aware about the advance directive, shall ascertain the genuineness and authenticity thereof with reference to the existing digital health records of the patient, if any, or from the custodian of the document.
Who Can Seek Procedure
An adult who is of a sound and healthy state of mind and in a position to communicate and comprehend consequences of executing the document.
The Instructions In The Document Must Be Given Due Weight By The Doctors
➤ It should be given effect to only after being fully satisfied that the executor is terminally ill and is undergoing prolonged treatment or is surviving on life support and that the illness of the executor is incurable or there is no hope of him/her being cured.
➤ If the physician treating the patient (executor of the document) is satisfied that the instructions given in the document need to be acted, upon, he shall inform the person or persons named in the advance directive, as the case may be, about the nature of illness, the availability of medical care and consequences of alternative forms of treatment and of remaining untreated.
Treatment Withdrawal
In such a situation, the nominee of the patient or the family member or the treating doctor or the hospital staff can seek permission from the high court to withdraw life support by way of writ petition under Article 226 of the Constitution.
Primary Medical Board
1 The physician/hospital where the executor has been admitted for medical treatment shall then constitute a primary medical board consisting of the treating physician and at least two experts of the specialty concerned with at least five years’ experience, who, in turn, shall visit the patient in the presence of his guardian/close relative and form an opinion preferably within 48 hours of the case being referred to it whether to certify or not to certify carrying out the instructions of withdrawal or refusal of further medical treatment. The decision shall be regarded as a preliminary opinion.
2 In the event the primary medical board certifies that the instructions contained in the advance directive ought to be carried out, the hospital shall then immediately constitute a secondary medical board comprising one registered medical practitioner nominated by the chief medical officer of the district and at least two subject experts with at least five years’ experience of the specialty concerned who were not part of the primary medical board. They shall visit the hospital where the patient is admitted and if they concur with the initial decision of the primary medical board of the hospital, they may endorse the certificate to carry out the instructions given in the advance directive.
3 The secondary board must beforehand ascertain the wishes of the executor if he is in a position to communicate and is capable of understanding the consequences of withdrawal of medical treatment. In the event the executor is incapable of taking decision consent of the person or persons nominated by the executor in the advance directive should be obtained regarding refusal or withdrawal of medical treatment
4 The hospital where the patient is admitted, shall convey the decision of the primary and secondary medical boards and the consent of the person or persons named in the advance directive to the judicial magistrate first class before giving effect to the decision to withdraw medical treatment.
If Permission Refused By Medical Board?
➤ It would be open to the person or persons named in the advance directive or even the treating doctor or the hospital staff approach the high court by way of writ petition under Article 226 of the Constitution
➤ If such an application is filed, the chief justice of the high court shall constitute a division bench to decide upon grant of approval or to refuse the same.
➤ The high court shall render its decision at the earliest as such matters cannot brook any delay and it shall ascribe reasons specifically keeping in mind the principles of “best interests of the patient”
Revocation Of Advance Directive By Patient
➤ An individual may withdraw or alter the advance directive at any time when he/she has the capacity to do so and by following the same procedure as provided for recording of advance directive. It must be in writing.
➤ If the advance directive is not clear and ambiguous, the medical boards concerned shall not give effect to the same and, in that event, the guidelines meant for patients without advance directive shall be made applicable.
➤ Where the primary medical board takes a decision not to follow an advance directive while treating a person, the person or persons named in the directive may request the hospital to refer the case to the secondary medical board for consideration and appropriate direction.
In Cases There Is No Advance Directive
➤ In cases where the patient is terminally ill and undergoing prolonged treatment in respect of ailment which is incurable or where there is no hope of being cured, the physician may inform the hospital which, in turn, shall constitute a primary medical board.
➤ In the event the board certifies the option of withdrawal or refusal of further medical treatment, the hospital shall then constitute a secondary medical board.
Difference between three kinds of mercy deaths
➤ Active Euthanasia: It mean killing a patient by active means, for example, injecting a patient with a lethal dose of a drug.
➤ Passive Euthanasia: This is legal in India. It is the refusal of treatment, or withdrawal of life support, to allow a patient to die.
➤ Assisted suicide: This happens when a patient is prescribed a drug's lethal dose, but patient selfadministers the medication.
Where active Euthanasia is legal
Countries with legalisation date
➤ Netherlands | Apr 1, 2002
➤ Belgium | May 28, 2002
➤ Luxembourg | Mar 19, 2009
➤ Colombia | Dec 15, 2014
➤ Canada | June 17, 2016
➤ Spain | June 25, 2021
➤ New Zealand | Nov 6, 2021
In the US
Active euthanasia is illegal. But, a patient has the right to passive euthanasia. Some states allow physician-assisted suicide, while most states allow the withdrawal of life-preserving interventions, such as respirators and feeding tubes.
In the UK
Active euthanasia is illegal. From 2003 to 2006, four failed bids were made to introduce bills for legalising active euthanasia. For passive euthanasia, patients may refuse treatment. Food and liquid can be withdrawn from a person in a vegetative state sans court nod.
English (US) ·