The Supreme Court of India recently simplified the rules on passive euthanasia in cases of terminal illness by removing red tape and constituting a time-bound process. This move, hailed by medical professionals as necessary, was preceded by a judgement in 2018 by a Constitution bench headed by justice KM Joseph, which recognized the right to die with dignity.
Background
- Prior to the 2018 judgement, passive euthanasia was a three-tier process that was cumbersome for all involved.
- Once the treating physician had confirmed that nothing more could be done to save the patient, a primary board was constituted by the hospital which gave its review. Then, a review board was put together by the collector, followed by approval or rejection from the district magistrate after verifying the facts.
- Doctors have repeatedly argued that beyond the first step, patients and their families tend to hit a wall, as the process is too legalised and lacks a human touch.
Key Changes
- According to the 2018 judgement, only a judicial magistrate could attest or countersign a living will, which would remain with the district court. In the apex court’s new judgement, this power has been given to a notary or a gazetted officer and the document will now be in the national health records accessible by hospitals.
- The requirements of what constitutes the primary board has been changed from at least four experts from general medicine, cardiology, neurology, nephrology, psychiatry or oncology with an overall 20 years of experience to three experts including the treating physician and two doctors with specialties and five years of experience.
- The 2018 judgement made no mention of any stipulated time within which a decision had to be made. Now, a secondary board must immediately be constituted by the hospital and the primary / secondary board must arrive at a decision within 48 hours on withdrawal of further treatment.
- Both boards will now be constituted by the hospital itself, removing the role of the collector.
Impact on Patients and Families
- Simplifying the process of seeking passive euthanasia is necessary, especially for those running out of money to keep up with providing care.
- The onus will be on the family to push for withdrawing futile care, and hospitals will be expected to take on the responsibility offered by the Supreme Court’s judgement.
Synopsis
The Supreme Court’s decision to simplify the rules on passive euthanasia is a step in the right direction, as it recognizes the right to die with dignity and streamlines a process that was previously too legalised and lacked a human touch. However, it remains to be seen if hospitals will actually take on this responsibility and if the changes will lead to more cases of euthanasia being carried out.