Brainstem death declaration, medical consensus on the patient’s prognosis, documented informed refusal from the patient or surrogate, and adherence to Supreme Court protocols are some of the major specific conditions that have been outlined in the Union Health Ministry’s draft guidelines for withdrawing life support in terminally ill patients.
The ‘Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients’ come weeks after the Supreme Court refused to grant an aged couple’s plea to allow “passive euthanasia” for their 30-year-old son, who has been lying comatose at home for 11 years after a fall from the fourth floor of a building. In 2018 also an elderly couple from Maharashtra had written to the President’s office, seeking permission for “active euthanasia”, where a person is killed, usually by administering an overdose of pain-killers.
The legality of euthanasia varies across the globe, with a small number of countries like Belgium and Australia permitting it under strict conditions.
As per the Ministry, these guidelines aim to ensure ethical decision-making while recognizing that many patients in critical care may not benefit from continued life support. The Ministry is seeking feedback from the stakeholders before finalizing the guidelines.
As per the draft, the conditions are whether the individual has been declared brainstem death, if there is a medical prognostication and considered opinion that the patient’s disease condition is advanced and not likely to benefit from aggressive therapeutic interventions, patient/surrogate documented informed refusal, following prognostic awareness, to continue life support and compliance with procedure prescribed by the Supreme Court.
It also states that doctors should take a considered decision to not start a life supporting measure in a terminally ill patient that is unlikely to benefit the patient and is likely to lead to suffering and loss of dignity.
In such a case, three conditions — on whether the individual has been declared brainstem death, if there is a medical prognostication and considered opinion that the patient’s disease condition is advanced and not likely to benefit from aggressive therapeutic interventions, patient/surrogate documented informed refusal, following prognostic awareness — has to be taken into account.
It also discusses the importance of Advance Medical Directives (AMD), which allow patients to specify their treatment preferences in advance.
However, IMA’s national President Dr R V Asokan stated that the proposed guidelines expose doctors to legal scrutiny and put them under stress.
“Such clinical decisions have always been taken in good faith by doctors.
The patient’s relatives are explained and given all information, taken into confidence in a given case and decision is taken on merit in every single case. Putting it down in sort of guidelines and also alleging that inappropriate decisions have been taken or they have been prolonged is misunderstanding the situation,” Dr Asokan told a news agency.
“First the perception and assumption that unnecessarily machines are used and lives are prolonged is wrong. It exposes the doctors to legal scrutiny.
“More so what is left of a doctor-patient relationship... Trying to define it in four corners of black and white documentation which is legally scrutinised is nothing but exposing the doctors to further stress,” he said.
Terminal illness in the draft guidelines has been defined as an irreversible or incurable condition from which death is inevitable in the foreseeable future. Severe traumatic brain injury which shows no recovery after 72 hours or more is also included.
