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3 months ago
Passive Euthanasia by SC: Know more about Advance directives (ADs) and Living Will

The apex court has permitted an individual to draft a living will specifying that they not be put on life support if they slip into an incurable coma. The order was passed by a five-judge Constitution bench of Chief Justice of India (CJI) Dipak Misra and Justices A K Sikri, A M Khanwilkar, D Y Chandrachud and Ashok Bhushan. Though the judges gave four separate opinions, all of them were unanimous that a ‘Living Will’ should be allowed. This is because an individual should not be allowed to continue suffering in a vegetative state when they don’t wish to continue living and know fully well that they will not revive. Dr KK Aggarwal, President Heart Care Foundation of India and Immediate Past national President IMA sheds light on few facts about euthanasia or living will in India.

Advance directives (ADs)

ADs are the documents a person completes while still in possession of decisional capacity about how treatment decisions should be made on her or his behalf in the event she or he loses the capacity to make such decisions. It is important to remember that ADs are only acted upon when the patient has lost the ability to make decisions for himself. It is also important to remember that ADs can be revoked orally or in writing by the patient at any time (so long as he or she has maintained decisional capacity).

  1. Durable Power of Attorney for Health Care (DPAHC or Health Care Proxy)
  2. Living Will (LW)

Living will

It is a document summarizing a person’s preferences for future medical care. The typical LW takes effect if the person is terminally ill without chance of recovery, and outlines the desire to withhold heroic measures. LW addresses resuscitation and life support. The LW gives a general sense of the patient’s wishes, and can be modified by the patient to include specific interventions such as cardiopulmonary resuscitation, ventilatory support, or enteral feeding.

The disparity between ADs and clinical decision-making was illustrated in a survey of physicians using six hypothetical clinical scenarios. Cases contained an explicit AD with a potential conflict between the directive and prognosis, wishes of family/friends, or quality of life. Physicians’ choices differed from the patients’ stated ADs in 65 percent of cases, suggesting that they viewed the AD as only part of the information needed to make treatment decisions

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