Guidelines for Dignified End-of-Life Care: Health Ministry Drafts Framework for Withdrawing Life Support in Terminally Ill Patients

(Source: Indian Express; Section: Explained; Page: 19)

 Analysis of News:   

What is Passive Euthanasia?

• • Euthanasia is the practice of ending the life of a patient to limit the patient’s suffering.

• Types of Euthanasia:

• • Active Euthanasia: 

• • • Active euthanasia occurs when the medical professionals, or another person, deliberately do something that causes the patient to die, such as administering a lethal injection.

• • Passive Euthanasia: 

• • • Passive euthanasia is the act of withholding or withdrawing medical treatment, such as withholding or withdrawing life support, with the intention of allowing a person to die.

Framework for Withholding or Withdrawing Life-Sustaining Treatment

• The guidelines call for the establishment of Primary and Secondary Medical Boards at hospitals.
• The Primary Board, led by the treating doctor, evaluates if continued treatment would benefit the patient.
• The Secondary Board, appointed by district health officials, reviews this decision, ensuring a thorough assessment before treatment is withdrawn.

Definition and Legality of Withholding/Withdrawing Life-Sustaining Treatment

• Withholding or withdrawing life-sustaining treatment involves stopping interventions that artificially sustain life (like ventilators), allowing a terminal illness to progress naturally.
• This approach, supported by the Supreme Court under Article 21 (Right to Life), aligns with a patient’s right to refuse treatment.

Advance Medical Directives and Living Wills

• An Advance Medical Directive (or living will) enables patients to specify treatment preferences in advance.
• Simplified by the Supreme Court in 2023, it requires an executor, two witnesses, and at least two surrogate decision-makers who can act on the patient’s behalf if they lose decision-making capacity.

Medical and Ethical Processes

• Hospitals constitute a Primary Medical Board (including the treating doctor and two experts) and a Secondary Medical Board (including a practitioner nominated by the district Chief Medical Officer) to confirm or veto withdrawal requests.
• Consent from surrogate decision-makers and notifications to a local magistrate are essential parts of this procedure.

Euthanasia vs. Withdrawal of Life Support

• Euthanasia involves actively ending a life, which differs fundamentally from the passive approach of life support withdrawal, aiming instead to reduce suffering without extending the dying process unnecessarily.
• The term “passive euthanasia” has often led to misconceptions, which the guidelines address.

Role of Doctors and Shared Decision-Making

• Doctors are not tasked with “playing God” but rather with guiding ethically informed decisions, collaborating with families to honor patients’ rights.
• This “shared decision-making” model respects patient autonomy, safeguards medical professionals, and ensures transparency and legal protection in sensitive cases.