Ronald Reagan’s Peaceful Passing

• Ronald Reagan, the 40th President of the United States, passed away in 2004 at the age of 93 after battling dementia for nine years.
• His wife, Nancy Reagan, described his peaceful death at home surrounded by family as “the greatest gift.”
• Reagan’s decline due to dementia allowed his loved ones to prepare for his passing and accept the natural course of his illness.

Contrasting with Atal Bihari Vajpayee’s Medical Journey

• In contrast, former Indian Prime Minister Atal Bihari Vajpayee faced a different end.
• Afflicted by a stroke nine years prior, he spent his final days in 2018 in the All India Institute of Medical Sciences in New Delhi, reliant on artificial life support systems.
• Vajpayee’s situation starkly contrasts Reagan’s, as he endured a prolonged period of non-ambulant existence, ultimately passing away while hooked to life support.

End-of-Life Care Trends: West vs. India

• The approach to end-of-life care varies between Euro-American countries and India.
• In Western nations, a growing number of individuals document advance medical directives, expressing preferences for a natural death when facing terminal illness.
• Studies show that in European ICUs, only 10.3% of patients die while on life support, with the rest transitioning to palliative care for a dignified passing.

Indian Reality: ICU Deaths and Ethical Concerns

• In India, however, approximately 70% of critically ill patients face death on life support systems, often alone in ICUs.
• Families grapple with hefty hospital bills and lack time to grieve amidst the impersonal ICU environment.

Ethical Considerations and Legal Ambiguity

• Despite the Indian Council of Medical Research’s definition of a healthcare provider’s duty to mitigate suffering, the reality in Indian ICUs diverges significantly.
• The routinization of intensive care deaths, a relatively recent phenomenon, reflects a societal discomfort with death and a lack of preparedness to make informed end-of-life decisions.
• The absence of clear legal frameworks exacerbates the situation, leaving both healthcare professionals and the public uncertain about their rights and responsibilities.

The Need for Death Literacy and Palliative Care

• A 2022 Report of The Lancet Commission emphasizes the importance of ‘death literacy’ to empower individuals to navigate end-of-life decisions confidently.
• Initiatives promoting palliative care, recognized as a fundamental aspect of the right to health by the World Health Organization, aim to ensure that individuals can live their final days with dignity and peace.

Role of Living Wills in End-of-Life Planning

• The concept of a living will gains significance in facilitating end-of-life planning.

• A living will allows individuals to outline their preferences for medical care in the event of incapacitation, ensuring their wishes are respected.
• By preparing a living will, having it witnessed and countersigned by a gazetted officer, and discussing it with family members, individuals can assert their autonomy and ensure a peaceful passing aligned with their desires.

Conclusion: Advocating for Dignified End-of-Life Care

• In conclusion, the contrasting experiences of Ronald Reagan and Atal Bihari Vajpayee underscore the importance of advocating for dignified end-of-life care.
• By fostering death literacy, promoting palliative care, and facilitating the use of living wills, societies can empower individuals to assert their rights and preferences, ensuring that all can face death with dignity and peace.