The Supreme Court on last week declared Passive Euthanasia and the right of persons, including the terminally ill, to give advance directives (Living Will) to refuse medical treatment permissible.

Passive Euthanasia is the act of withdrawing or withholding medical support to a dying patient who has no hope for revival or cure. In the historic judgement, SC held that the fundamental right to life and dignity under Article 21 of the Constitution includes ‘right to die with dignity’. Dignity is lost if a person is allowed or forced to undergo pain and suffering because of un-warranted medical support.

Justice Chandrachud observed that to deprive a person of dignity at the end of life is to deprive her or him of a meaningful existence. Meaningful existence include a person’s right to self determination and autonomy to decide his medical treatment.

He also said that modern medical science should balance the quest to prolonging life with the task of ensuring ‘quality of life’; one is meaningless without the other.

While recognizing passive euthanasia, the SC allowed advance directive or living will, by which patients can spell out whether treatment can be withdrawn if they fall terminally ill or are incompetent to express their opinion.

It will be doctor’s call

SC placed the burden of making a call on the treating physician and hospital. The responsibility is on doctor to ascertain the genuineness and authenticity of the living will of a terminally ill patient from the judicial magistrate in whose custody the document is to be kept.

Once satisfied there is no cure the doctor has to give due weight to the living will. After the doctor decides that living will needs to be acted upon it is her or his responsibility to convey to the guardians the medical condition, availability of care and consequences of alternative forms of treatment and the consequences of remaining untreated.

The physician or the hospital has to constitute a medical board consisting of a head of treatment department and at least 3 experts from the field of general medicine, neurology, cardiology, nephrology, psychiatry or oncology with experience in critical care and standing of 20 years of profession experience.

In case the medical board decides not to follow the living will, it can apply to the district collector concerned.

The Hindu reported that “The court gives the treating doctor even a right to move the High Court, along with the dying person’s relatives or guardian, in case the Medical Board revokes permission for passive euthanasia.”

It also reported that – In such a case, the high court is free to form an independent committee of doctors to re-look the case and take a decision. Once the treatment is withdrawn, the Magistrate has to inform the high court.

The court also gives an individual the right to withdraw or alter his Living Will, but only in writing.

The court held that a Living Will shall not be applicable to the treatment in question if there are “reasonable grounds for believing that circumstances exist which the person making the directive did not anticipate at the time of the advance directive and which would have affected his decision had he anticipated them”.

In case it supports the living will, the doctor or the hospital will inform the district collector, who will also form a medical board with chief medical officer for the endorsement of decision.

Living will

Living Will is a healthcare directive, in which people can state their wishes for their end-of-life care, in case they are not in a position to make that decision

Who can make it?: An adult with a sound and healthy mind. It should be voluntarily executed and based on informed consent. It should be expressed in specific terms in a language “absolutely clear and unambiguous”.

What it should contain?: The circumstances in which medical treatment should be withheld or withdrawn. It should specify that the Will can be revoked any time. It should give the name of the “guardian or close relative” who will give the go-ahead for starting the procedure of passive euthanasia. If there are more than one Living Will, the latest one will be valid.

Laws surrounding euthanasia in various countries

Netherlands: in 2002 Netherlands became the first country to legalize euthanasia and assisted suicide.

U.S.: doctors is allowed to prescribe lethal dose of medicine to terminally ill patients in 5 states but euthanasia is illegal

Germany: physician assisted suicide is legal if the drug is self administered by the patient.

South Korea: since 2008, ‘die well’ law allows the incurably ill South Koreans to refuse life prolonging treatment.

Places where euthanasia is illegal: U.K., Australia, New Zealand, Philippines

Read full judgement here

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