Why in news?

The 'Draft Guidelines for Withdrawal of Life Support in Terminally Ill Patients,' was released by the Union Health Ministry. Feedback and suggestions have been invited from the stakeholders on the draft by October 20.

While doctors have been informally advising families to withdraw care for terminal patients, there was no formal legal framework.

What’s in today’s article?

• Euthanasia (Meaning, Types of Euthanasia, Legality in India)
• Draft guidelines on passive euthanasia

Euthanasia

• About
  • It is defined as the hastening of death of a patient to prevent further sufferings.
• Types
  • Active Euthanasia
    • Active euthanasia refers to the physician deliberate act, usually the administration of lethal drugs, to end an incurably or terminally ill patient’s life.
    • There are three types of active euthanasia, in relation to giving consent for euthanasia, namely:
      • Voluntary euthanasia – at patient request,
      • Nonvoluntary – without patient consent,
      • Involuntary euthanasia – patient is not in a position to give consent.
  • Passive Euthanasia
    • Passive euthanasia refers to the intentional withholding or withdrawal of medical treatments or life-sustaining interventions, allowing a person to die naturally from their underlying condition.
    • This can include stopping treatments like ventilators, feeding tubes, or medications that keep the patient alive.
    • Decisions for passive euthanasia are typically made based on the patient's wishes, advance directives, or through family members and healthcare proxies when the patient cannot make decisions themselves. 
• Legality in India
  • Passive euthanasia
    • A five-judge bench of the Supreme Court in Common Cause vs Union of India (2018) recognised a person’s right to die with dignity.
      • It said that a terminally ill person can opt for passive euthanasia and execute a living will to refuse medical treatment.
    • The Court permitted an individual to draft a living will specifying that she or he will not be put on life support if they slip into an incurable coma.
    • The Court recognised the right to die with dignity as a fundamental right and an aspect of Article 21 (Right to Life).
  • Active euthanasia
    • In India, active euthanasia is a crime. Only those who are brain dead can be taken off life support with the help of family members.
• Legality in other parts of the world
  • Euthanasia is legal in several countries. Euthanasia is legal in the Netherlands, Belgium, Luxembourg, and Spain.
  • Switzerland allows assisted suicide.
  • Canada permits both euthanasia and assisted suicide, while certain U.S. states, such as Oregon, Washington, and California, allow assisted suicide under strict regulations. Colombia has legalized euthanasia.
  • Each country or region has specific criteria, such as terminal illness or unbearable suffering, that must be met for euthanasia or assisted suicide to be performed legally.

Draft guidelines on passive euthanasia

• Defined terminal illness
  • The draft has defined terminal illness as an irreversible or incurable condition from which death is inevitable in the foreseeable future.
• Based on four conditions
  • The guidelines for withdrawing or withholding medical treatment in terminally ill patients are based on four key conditions:
    • The individual has been declared brainstem dead.
    • There is a medical assessment that the patient's condition is advanced and unlikely to improve with aggressive treatment.
    • The patient or their surrogate has provided informed refusal to continue life support after understanding the prognosis.
    • The procedure follows the directives set by the Supreme Court.
• Allow patients to decide on life support and resuscitation
• Developed by AIIMS experts, these guidelines allow patients to decide on life support and resuscitation.
• They also permit the withdrawal of supportive care such as ventilation or dialysis if a patient is brain dead, unlikely to benefit from further intervention, and if the patient or surrogate refuses care.
• Provisions related to advance medical directives
  • The guidelines also mention advance medical directives, where individuals document their treatment preferences in case they lose decision-making capacity.
  • The physician, upon deeming life-sustaining treatments inappropriate, will refer the case to a primary medical board for review.
  • If the board agrees, a shared decision is made with the family, and a secondary medical board’s approval is required before withdrawing support.