LIVING WILL

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Context: The Bombay High Court has criticised the Maharashtra government for not having a proper mechanism in place to enforce living wills.

About LIVING WILL

• A Living Will, legally known as an Advance Medical Directive (AMD), empowers a person to designate another individual to make medical treatment decisions on their behalf if they become unconscious

The Legal Framework of Living Wills in India

• The concept of Living Wills in India originates from the landmark 2018 Supreme Court judgement in Common Cause (A Regd. Society) v/s Union of India and Anr. The Court recognized the legality of passive euthanasia and allowed patients to execute an AMD, detailing their end-of-life medical preferences.
• The judgement laid out comprehensive guidelines for:
  • Executor Competence and Directive Creation: Specifying who can create a Living Will and the method for doing so.
  • Directive Content and Preservation: Outlining what the directive should contain, how it should be recorded, preserved, and registered.
  • Medical Board Oversight: Establishing the circumstances under which the medical board can refuse a directive and the processes for revocation or inapplicability.

Euthanasia ●Euthanasia is the deliberate act of ending someone's life to alleviate their suffering. It is often performed by doctors upon request from terminally ill patients experiencing unbearable pain. The decision to perform euthanasia involves considering local laws, the individual's physical and mental health, and their personal beliefs and wishes. ●Euthanasia can be active or passive. ○Active euthanasia is when a doctor directly ends someone's life, such as by giving a lethal dose of a sedative. ○Passive euthanasia involves withholding or limiting life-sustaining treatments, allowing a person to pass more quickly. This can include prescribing high doses of pain medication, which can become toxic over time. ● The line between passive euthanasia and palliative care, which focuses on keeping people comfortable at the end of their lives, can sometimes become blurry. ●Euthanasia can also be voluntary or involuntary. Voluntary euthanasia occurs when someone consciously decides to seek help in ending their life, providing full consent and understanding. Involuntary euthanasia involves someone else deciding to end a person's life, usually a close family member when the person is unconscious or permanently incapacitated.

 The Supreme Court's guidelines also provided for the establishment of medical boards:

• Primary Board: This board is responsible for informing the family members of a terminally ill patient about the implications of withdrawing medical treatment and obtaining written consent.
• Secondary Board: Upon the Primary Board's recommendation, a Secondary Board, chaired by the Chief District Medical Officer and comprising three medical experts, must validate the decision. The Secondary Board’s approval is necessary to proceed with the withdrawal of medical treatment.

If the Secondary Board validates the withdrawal of treatment, they must seek approval from the Judicial Magistrate First Class (JMFC), who will conduct an inquiry and either approve or deny the decision. In cases of disagreement or rejection, family members can approach the High Court under Article 226 of the Constitution.

2023 Modifications to the Guidelines

The Supreme Court, in Common Cause (A Regd. Society) v. Union of India and Anr. (2023), introduced the following changes:

• Directive Authentication: The AMD must now be attested before a notary or Gazetted Officer.
• Custodian Appointment: The responsibility of appointing a custodian for the directive shifted from the JMFC to local government authorities, such as Municipal Corporations or Panchayats.
• Streamlined Procedures: The Secondary Board’s decision no longer requires JMFC verification, simplifying the process.

A Living Will allows terminally ill patients to:

• Ensure Their Wishes Are Honoured: Patients can specify their preferences regarding life-sustaining treatments and other medical decisions.
• Relieve Family Burden: The directive provides clarity and reduces the emotional burden on family members by documenting the patient's wishes when they are in a conscious state.
• Empower Trusted Individuals: Patients can designate a trusted person to make critical medical decisions on their behalf.

Conclusion

• Living Wills are crucial for ensuring that individuals' end-of-life medical preferences are respected and for reducing the burden on families during difficult times. The legal framework established by the Supreme Court of India, along with recent modifications, aims to facilitate the creation and execution of Living Wills, ensuring that patients can die with dignity and their wishes are upheld.

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LIVING WILL

Source:

Indian Express

Indian law

PRACTICE QUESTION Q. What is the primary difference between active euthanasia and passive euthanasia? A) Active euthanasia involves direct intervention to end a patient's life, while passive euthanasia allows natural death. B) Active euthanasia is legal in all countries, while passive euthanasia is only legal in some jurisdictions. C) Active euthanasia requires family consent, while passive euthanasia does not. D) Active euthanasia is reversible, while passive euthanasia is irreversible. Answer:  A