India has begun framing guidelines on so-called “passive” euthanasia that would lay out conditions for shutting off life support for terminally ill patients. But medical and religious organisations have expressed concerns that the norms would place too much responsibility on doctors to make decisions between life or death.
While India does not permit “active” euthanasia, which involves use of substances such as lethal injections or external force to end life, court rulings have permitted clinicians to withhold life-prolonging treatment in certain cases.
Now the government has drafted guidelines to standardise such decisions and is seeking expert feedback on the proposals.
According to the Health Ministry’s draft, published on 30 September, doctors must take considered decisions in a patient’s best interest in cases involving an incurable condition from which death is inevitable in the foreseeable future.
Life support may be forgone or discontinued at the request of terminally ill patients themselves, including through advance instructions for how they would like to be medically treated after losing decision-making abilities.
Alternatively, doctors may judge treatment more likely to cause suffering than benefit. In that case, the draft said, they must refer the case to a panel of other physicians for review.
If the board agrees, there will be another multi-disciplinary meeting with family and a shared decision will be made. In some circumstances, a second board of doctors must approve too.
Medical, religious opposition
India’s Supreme Court in 2018 ruled a terminally ill patient can seek passive euthanasia through a “living will”. Five years later, judges simplified the order and asked the government to prepare permanent rules.
The Indian Medical Association, which has 350,000 doctors on its rolls, said it would study the draft and advise the government to tweak its provisions if needed.
Association president RV Asokan warned that “the guidelines could expose doctors to legal scrutiny and increase stress in their decision-making”.
“The perception and assumption that machines are unnecessarily used to prolong lives is wrong. It exposes doctors to legal scrutiny,” he told news agency PTI.
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Meanwhile many Christian activists are opposed to any form of euthanasia, which they argue is ripe for abuse.
“Relatives may want to get rid of an old patient who they take to be a burden on them and their freedom,” John Dayal, former president of the All India Catholic Union, told RFI.
“In a land where kidneys are stolen from beggars and rickshaw-pullers when they have been drugged into sleep, can we trust the medical profession and the law and justice system to be the watchdog guardian?”
Regulatory gap
But others involved in frontline care said the guidelines would help close a regulatory gap.
“We have been doing this for years,” said Sushma Bhatnagar, a professor of palliative care at the All India Institute of Medical Sciences in Delhi, whose experts helped formulate the guidelines.
“Once we know that a patient is terminal, we counsel them and their family members to withdraw care. They are usually made comfortable and sent home. However, there was no guideline or legal procedure for the same,” she told the Indian Express.
Except in cases of medical emergency, she said, many patients prefer to spend their final days with their family rather than in intensive care.
By next year, 189 million people will be over 60 years of age and fuel demands for 175 million additional hospital beds in India, where 32 million people fall below an official poverty line every year because of medical bills.
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