Euthanasia verdict. Patient’s will to prevail over clinical opinion

The medical community seems to have endorsed Friday’s Supreme Court judgment to permit passive euthanasia, and prioritise the patient’s will over clinical opinion.

Doctors will have to respect a patient’s will, says KK Aggarwal, former president of the Indian Medical Association, explaining the verdict that recognised the “living will”.

“We declare that an adult human being with the mental capacity to take an informed decision has right to refuse medical treatment, including withdrawal from life-saving devices,” the apex court’s 538-page judgment read, opening the floodgates for many more discussions on “end-of-life” support and care.

A person will now be able to write a “living will” on the “irreversible or irrecoverable” conditions under which they would not be put on life-support, says Aggarwal. The patient’s will would prevail even if doctors hold a different clinical opinion, he added. Individuals may have several options available to them to take control of their life and death, Aggarwal said, explaining terms like “proxy will” (where a spouse takes the final call on withdrawing or withholding treatment), an advance medical directive (where a power of attorney for healthcare is required) or a DNR (do not resuscitate) situation.

By acknowledging the “living will” it is the autonomy of the patient that is being respected, says Roopkumar Gursahani, consultant neurologist with Hinduja Hospital. The patient’s will is the first principle of bio-medical research, he says.

Letting go

Death should be discussed at the dinning table, Gursahani says, calling for more conversations on how people would like to live out the end of their lives. The judgment is just the first stage of many more steps, including a comprehensive legislation on the issue, supportive care, ironing out issues around access to pain-management medicine, and, most importantly, training doctors to ‘let go’.

Doctors are trained to cure and fight against disease; so now they need to be trained to allow the graceful pass-over, the neurologist says. It is a “teachable skill”, he says, on getting doctors to convey bad news and discuss end-of-life choices.

The country has been discussing what is referred to as “passive euthanasia” for sometime now and even came out with the draft Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill. But doctors then raised the issue of a the “living will” that had not been discussed in the draft.

The discusssion hit national headlines after Mumbai hospital nurse Aruna Shanbaug led a vegetative life for 42 years after being the victim of a brutal attack and rape. The nurses in the hospital took care of her as one of their own till she passed away in May 2015.

Ethical clearances

As doctors pore through the judgment, Aggarwal says, detailed guidelines will be put in place on the medical board that will ensure that a patient’s “living will” was indeed done with informed consent, and with no coercion, etc.

Gursahani added that boards should be set up in each hospital, instead of its existence at the State-level, to prevent prolonging the agony for patient and family.

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