Fw: RTI Replies: Advance Medical Directive
HOPE CLINICS
After the Aruna Shanbaug judgment, the Supreme Court of India opened the door to passive euthanasia. However, the procedure outlined was considered too complicated and time-consuming. In 2018, in the case of Common Cause Society of India vs. Union of India, the Supreme Court laid down steps to withdraw life support for terminally ill patients with no hope of recovery. Despite these guidelines, the process remained cumbersome, prompting the Critical Care Society to approach the Supreme Court once again for simplification. The Court responded by making the procedure more accessible.
Every day, in major hospitals across the country, at least one patient's relatives request doctors to remove life support. When a patient is brought to the emergency department, families initially implore doctors to do everything possible, regardless of the cost. However, after three days in the ICU on a ventilator, financial constraints often weaken their resolve. Many families, unable to bear the mounting expenses of intensive life support, resort to taking loans—both secured and unsecured—while pressuring doctors to either continue treatment or withdraw life support.
Despite the Supreme Court’s efforts to simplify the procedure, we at MLAG observed no significant change on the ground. According to the guidelines, all cases where life support is withdrawn must be documented in a registry maintained by local courts and reported to the respective High Courts. To assess compliance, we filed Right to Information (RTI) requests with nearby High Courts and major hospitals, inquiring about instances where the prescribed procedure for removing life support had been followed.
Our findings were alarming. Except for a single case reported by Fortis Hospital Mohali to the Punjab & Haryana High Court, neither PGIMER, G. B. Pant Hospital, nor SGPGI Lucknow had records of any such cases. Even the Bombay High Court responded negatively when asked for similar information.
This raises a fundamental question: Why is it that neither lawmakers nor the judiciary can create laws that an average law-abiding citizen can follow? The information we obtained suggests that, over the preceding one and a half years, the legal provisions for passive euthanasia have provided little to no relief for those facing this heart-wrenching dilemma. To my simple mind, lawmakers must provide clear, unequivocal answers to the following questions:
Can doctors remove a ventilator from a patient who is not brain-dead but appears incurable at the request of the relatives?
Can doctors withdraw feeding tubes, antibiotics, and other supportive treatments from a patient in a coma or a vegetative state if the relatives request it?
Can doctors remove a ventilator and other life support from a patient who is not suffering from an incurable disease but has issued an advance directive specifying its withdrawal after a particular duration of treatment?
