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LETTER TO THE EDITOR
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 174-175

Comments on the Formulation of Law on Passive Euthanasia and its Draft Bill ‘Terminally Ill Patients (Protection of Patients and Medical Practioners)’


1 Department of Surgery, University College of Medical Sciences (University of Delhi), New Delhi, India
2 School of Development, Azim Premji University, Bangalore, Karnataka, India

Date of Web Publication24-Oct-2017

Correspondence Address:
Vivek Ratna Minocha
Sector A 15 Noida 201 301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_55_17

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How to cite this article:
Minocha VR, Mishra A. Comments on the Formulation of Law on Passive Euthanasia and its Draft Bill ‘Terminally Ill Patients (Protection of Patients and Medical Practioners)’. MAMC J Med Sci 2017;3:174-5

How to cite this URL:
Minocha VR, Mishra A. Comments on the Formulation of Law on Passive Euthanasia and its Draft Bill ‘Terminally Ill Patients (Protection of Patients and Medical Practioners)’. MAMC J Med Sci [serial online] 2017 [cited 2019 Aug 18];3:174-5. Available from: http://www.mamcjms.in/text.asp?2017/3/3/174/217128

Sir,

It is appreciated that a long overdue, sensitive and emotive issue concerning euthanasia is being debated to consider it within a legal framework and to initiate legislative process.

The current exercise is dealing exclusively with passive euthanasia primarily following the observations of the Supreme Court in the Aruna Shanbaug case and the subsequent recommendations of the Law Commission. Confining and restricting deliberations only to one aspect of the wide spectrum of euthanasia-related issues is unfortunate. The legislative exercise should be comprehensive and encompass all aspects of the issue including passive and active euthanasia, the decision making process, who should implement the decision, dangers and safeguards, social and cultural dimensions, required changes in medical ethics, the code of conduct and administrative adjustments. The title for deliberation should read as ‘Formulation of Law on Euthanasia’.

In any deliberation or discussion on euthanasia, a distinction between passive and active euthanasia may not be helpful. Euthanasia is mercy killing with an objective of alleviating pain and suffering of patients who are terminally ill and in a permanent vegetative state. As rightly explained in the Annexure, passive euthanasia is withholding interventions, and active euthanasia involves taking specific steps. The objective for both is the same: causing death in pre-determined situations, where death is considered a better option than prolonging life. According to one perspective, passive euthanasia goes against the spirit of peaceful death envisaged in euthanasia, that is, ‘mercy killing’. It may be pointed out that the techniques employed in passive euthanasia, that is, withholding/withdrawal of tubes for feeding or for relief of respiratory distress, enhance the misery as a result of starvation, dehydration and breathing difficulty. Such misery may be a prolonged affair, and the relatives and attendants face the ordeal. It is worthwhile recalling the case of Ms. Teri Schiavo in the US, who was granted euthanasia and took 13 days after initiating the process! It must have been a disturbing experience for the well wishers to witness the slow process of death. Therefore, it is argued that the distinction between passive and active euthanasia needs to be abolished.

The current frame is to consider euthanasia under the doctrine of ‘rights’: patients’ right to die as a follow up of patient’s right to life. The person may have expressed his desire for euthanasia verbally or in writing in the case of irreversible terminal illness: in effect a ‘living will’. However, medical opinion/judgment is still required to determine whether a situation of hopelessness and irreversibility has actually reached to carry out the wishes as per ‘living will’. Taking an overall view, euthanasia when seen in the context of human rights becomes an emotive issue with contradictory and irreconcilable ideological positions. The relatives face a severe dilemma when faced with a situation to decide about euthanasia.

An alternate approach is to locate euthanasia not within the blanket domain of human rights but as a professional opinion − a kind of medical prescription based on objective considerations and like other medical advices is subject to ‘informed consent’ by the legally valid representative. A ‘living will’ will be useful in this context though not essential.

One of the major issues is to formulate guidelines for conditions under which euthanasia may be considered for recommendations. These ‘guidelines’ must clearly state the diseases and points in the progression of disease at which termination is considered a better option than the continuation of life. A clear and widely accepted understanding of the indications for euthanasia is very important. These ‘guidelines’ should be a part of the Act, and for this purpose a ‘Task Force’ maybe constituted consisting of a wide spectrum of clinical disciplines including end-of-life caregivers, social science experts, ethicists and social activists. Under the doctrine of bringing euthanasia as a professional decision and lifting it from the domain of rights, a clear and widely accepted understanding of the indications for euthanasia is essential. The final report of the ‘Task Force’ reflecting criteria for euthanasia should be incorporated in the Act.

It is equally important to determine in an individual case whether or not the parameters as per ‘guidelines’ for euthanasia are fulfilled. For the purpose, the Medical Board may be entrusted the responsibility. The composition and jurisdiction of the Board, the initiator and the process of evaluation will be decided by the administrative set-up. The efforts have to be directed at ensuring the decisions are taken in the best interests of patients minimizing misuse of the provisions for ulterior extraneous motives.

In an effort to avoid errors, a system of built-in mechanism of legal pre-scrutiny may be provided. The recommendations and detailed notes of the Board could be sent to the designated court to establish a satisfactory compliance of the criteria laid down without any extraneous consideration. The finality of the recommendation is reached only on confirmation, following which subsequent actions could begin. The standard operating procedures in the medical establishment will have to make provision to accommodate euthanasia including type, methods and specifying who will carry out euthanasia. The medical ethics and code of conduct will have to be suitably modified to suit the requirements of euthanasia. Then there is an issue concerning death certification, which must be treated as valid document particularly for insurance even if the fact of euthanasia is mentioned. The legislative action must incorporate this concern.

Some aspects of social science perspective have been dealt elsewhere (Minocha et al., 2011:E.P.W. Dec 3, 2011; pp. 25–28). A scanned copy of the paper is attached.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




 

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