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New Delhi, Oct. 3: The law commission has recommended a “separate legislation” to deal with withdrawal of life support to those terminally ill, saying such patients who were in extreme pain but had little chance of recovery had the right to refuse treatment.
The suggestion, which came in response to a law ministry query last year on whether such a standalone law was required, will have to be placed before the cabinet for approval.
The recommendation is part of the commission’s latest report — Passive Euthanasia — A Relook — in which it changed some of the provisions of a draft bill that dealt with the sensitive issue.
The Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill, 2006, has been in cold storage for the past six years.
The commission’s proposals also include protection from prosecution for both patients and their doctors.
“There is a dire need to have a separate legislation as laws make people more aware and also make the doctor free to suggest such options to patients. I also think this is long overdue as a terminally ill patient has the right to choose death as he has the right to choose life,” said R.K. Mani, director, critical care unit, Artemis Health Institute Hospital, and former president of the Indian Society of Critical Care Medicine.
The commission’s report has drawn on the Supreme Court judgment last year in the Aruna Shanbaug case, where the court said passive euthanasia should be allowed “under exceptional conditions”. Shanbaug, a nurse, was brutally assaulted in 1973, and has been immobile since.
The court issued a set of guidelines, which form the basis of the draft proposals.
According to the draft, “every patient who has an illness, injury or degeneration of physical or mental condition which is causing extreme pain and suffering and which, according to reasonable medical opinion, could lead to death” has the “right” to request “withdrawal… of... treatment”.
The draft says the next of kin of patients who are brain dead or have a persistent and irreversible vegetative condition can approach courts with due medical guidance to seek withdrawal of life support.
The commission, however, clarified that when a patient communicates his or her decision to the doctor concerned, it would be binding on the doctor. But the doctor has to be satisfied that the patient has taken an informed decision based upon his or her free will.
“I wouldn’t like to call this passive euthanasia. It’s a wrong terminology. This is the right of giving legal sanction to the rights of patients to refuse treatment. This is a basic right. This will make doctors more comfortable and also give the patient the right to die in dignity,” Mani said.
In its draft proposals, the commission has also dealt with the age of patients, which the earlier bill did not.
The commission has defined “minor” as someone below 16 and changed the earlier bill to take into account the will of a patient who is above 16 but below 18. The commission said those below 16 were “incompetent” to take a decision without the permission of an adult next of kin.
“Treat the informed decision taken by a patient above 16 years (but below 18 years) at par with the decision taken by a competent patient, subject to the condition that in such a case, the major spouse and one of the parents or major son or daughter of such patient has given consent for discontinuance of treatment. Having regard to the level of understanding and capacity of the present generation youngsters, it is considered appropriate to introduce this provision, subject to the additional safeguards,” the report said.
The draft recommended that the director-general of health services at the Centre and the director of medical services (or any officer holding an equivalent post) in each state set up a panel of medical experts to deal with cases.
The report has issued guidelines to doctors to maintain records of terminally ill patients — such as name, age and address — along with information on their next of kin.
The draft said requesting passive euthanasia was not akin to suicide and patients should not be punished under any law.
“Where a competent patient refuses medical treatment in circumstances (as mentioned in the draft), notwithstanding anything contained in the Indian Penal Code…, such a patient shall be deemed to be not guilty of any offence under that code or under any other law for the time being in force,” the commission said.
It added that doctors who abide by the provisions of the proposed law cannot be booked for assault, medical negligence or murder.
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