Wednesday, 11 May 2016

Whose life is it anyways?

                                  Whose life is it anyways?

We have all come across patients, relatives who are suffering from a terminal life condition, in extreme distress and pain with no wish to prolong the agony and wanting it all to end. As doctors we are obligated to manage them fully aware that their continued living on in their condition has no value or hope and as relatives we are unable to see their suffering. We all wish we could do something like Euthanasia- also called mercy killing which is the act of putting to death  painlessly or allowing to die, as by withholding extreme medical measures, a person suffering from an incurable, especially a painful, disease or condition.
Unfortunately this is not legally allowed in our country as yet. 

The good news is that the government is seeking public opinion to allow this practice with certain restrictions and we may soon have this merciful options for the needful cases
Euthanasia (from Greek: εὐθανασία; "good death": εὖ, eu; "well" or "good" – θάνατος, thanatos; "death") is the practice of intentionally ending a life in order to relieve pain and suffering.

There are different euthanasia laws in each country. The British House of Lords Select Committee on Medical Ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering". In the Netherlands and Flanders, euthanasia is understood as "termination of life by a doctor at the request of a patient".

Euthanasia is categorized in different ways, which include voluntary, non-voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-voluntary euthanasia (patient's consent unavailable) is illegal in all countries. Involuntary euthanasia (without asking consent or against the patient's will) is also illegal in all countries and is usually considered murder. As of 2006, euthanasia is the most active area of research in contemporary bioethics.

In some countries there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia. Those who are against euthanasia may argue for the sanctity of life, while proponents of euthanasia rights emphasize alleviating suffering, and preserving bodily integrity, self-determination, and personal autonomy. Jurisdictions where euthanasia is legal include the Netherlands, Canada, Colombia, Belgium, and Luxembourg.

In India, the issue of euthanasia rose to prominence after several noteworthy cases including that of Aruna Shanbaug, a nurse who spent 42 years in a vegetative state as a result of a violent sexual assault.

In a public interest litigation filed in 2005 by NGO Common Cause, which said that when a medical expert opines that the person afflicted with a terminal disease has reached a point of no return, then he or she should be given the right to refuse life support as it would only prolong their pain, the Supreme Court issued notices to states and Union Territories on the issue. The Centre had also strongly opposed the petition earlier, saying it is a form of suicide.
But now terminally ill patients could get the right to die by rejecting treatment as Health Ministry prepares the controversial 'euthanasia Bill' as The Medical Treatment of Terminally Ill patients (protection of patients and medical practitioners) Bill is up for public debate.

Dr Jagdish Prasad, Director General of Health Services (DGHS) has said that  “Based on the recommendations of the Law Commission, and after examination of the draft Bill in Health Ministry, we are contemplating to enact a law on passive euthanasia,” . He further added that “For taking an informed decision in this matter, we have solicited public opinion and comments on the subject. After we get the comments and views from the public, we will implement it,”. 

The bill would be looking at considering passive euthanasia which involves withholding common treatments such as ventilators from terminally ill patients, when they are necessary for the continuance of life. Active euthanasia involves the use of lethal substances or forces, such as injections to kill, and is the most controversial form and “has not been recommended in The Medical Treatment of Terminally Ill patients (protection of patients and medical practitioners) Bill. 

Active Euthanasia is not being considered by Health Ministry as it is more likely to be misused by unscrupulous individuals to attain their ulterior motives,” said Prasad.

The 241st report of the Law Commission, proposed the draft Bill and deals with passive euthanasia and the living will, a document in which a person states his or her desire to accept or reject extraordinary life-prolonging measures. These are techniques used when it is not possible for a patient to recover from a terminal condition.

As and when the law is approved, the Medical Council of India (MCI) will have an active role in it, by preparing and issuing guidelines for medical practitioners in the matter of withholding or withdrawing medical treatment from competent or incompetent patients suffering from terminal illnesses.

We hope this law gets passed and quickly to enable all those suffering to have a say in their will to continue or end their life with dignity. For-whose life is it anyway?

Current MCI Position: Ethics Regulation 6.7 EuthanasiaPracticing euthanasia shall constitute unethical conduct. However on specific occasion, the question of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death, shall be decided only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare withdrawal of support system. Such team shall consist of the doctor in charge of the patient, Chief Medical Officer / Medical Officer in charge of the hospital and a doctor nominated by the in-charge of the hospital from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994. 

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