Validation of living will a tedious process

Validation of living will a tedious process

Validation of living will a tedious processSupreme Court guidelines will be followed until legislation is formed, says panel constituted by Health dept

A five-member committee constituted by the State Health Department to formulate guidelines to prepare Advance Medical Directives (AMD) or “living will” has, while keeping itself within the procedural framework insisted on by the Supreme Court, expressed its anxiety that the tedious process involved in validating an AMD could make it all the more difficult for the common man to exercise his right to die with dignity.

The committee, chaired by M.R. Rajagopal, chairman, Pallium India, had been constituted in the backdrop of a Supreme Court judgment in March last, when the court held that the right to die with dignity was a fundamental right. It had held passive euthanasia and a living will as legally valid.

The committee, which submitted its report this week, says the terminology “passive euthanasia” is a misnomer. It draws on ICMR’s documents to point out that euthanasia is the intentional act of killing a terminally ill and dying patient by the intervention of a doctor. But allowing natural death and withholding/withdrawing life-sustaining treatment to limit the suffering of a dying patient should not be construed as euthanasia.

The Supreme Court judgment recognised the right of an individual of sound mind to prepare a living will, refusing futile or unnecessary medical treatment to prolong life, in the event of a terminal illness.

“The court has stipulated how an ADM may be prepared and executed, with a lot of safeguards, to prevent its misuse. We have expressed our apprehension regarding the tedious process of preparing and executing an ADM. But till the Centre or the State forms a law, we have no option but to follow the Supreme Court guidelines, however cumbersome it may be,” says Dr. Rajagopal.

The committee has recommended that artificial life-support measures may be withdrawn/withheld in the event of any terminal illness as defined by ICMR. It has recommended that every District Collector authorise the district medical officer (DMO) to prepare a panel of at least 25 doctors, from various specialities, so that the process of executing AMD can be expedited.

“What the committee has done is unravel the 200-page SC judgment and lay out in clear terms how a living will may be prepared and executed. But even when there is no living will, and the patient is terminally ill and undergoing prolonged treatment without any hope of cure, the family can follow these procedures to withdraw life-prolonging treatment,” says H.V. Easwer, Professor of Neuro Surgery, SCTIMST, and a member of the committee.

With a huge and ailing geriatric population, apprehensions about futile life-prolonging medical care in ICUs is a reality that many families in Kerala face on a daily basis. In the absence of any Centre or State legislation on the subject, better public awareness of the current guidelines on living will is the need of the hour.

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