Govt issues draft rules for withdrawal of life support in terminally-ill patient

The Ministry of Health and Family Welfare released draft guidelines for the withdrawal of life support in terminally ill patients. The guidelines stated that the decision should be a “considered” one made by doctors, taking into account specific medical conditions and the patient’s overall health status.
The draft is titled: “Guidelines for Withdrawal of Life Support in Terminally ill Patients”. The draft stated, “A considered decision in a patient’s best interests, to stop or discontinue ongoing life support in a terminally ill disease that is no longer likely to benefit the patient or is likely to harm in terms of causing suffering and loss of dignity.”
According to the draft guidelines, the withdrawal of life support includes four conditions:
The draft also states that doctors should not consider the decision to not start a life supporting measure in a terminally-ill patient that is unlikely to harm in terms of suffering and loss of dignity.
“A considered decision in a patient’s best interests, to not start a life supporting measure in a terminally ill patient, that is unlikely to benefit the patient and is likely to harm in terms of suffering and loss of dignity,” as per the draft.
It explains further that in such a situation, three conditions on whether the individual has been declared brainstem dead, if there is a medical prognostication and considered opinion that the patient’s disease condition is advanced, individual declared brainstem death as per the Transplantation of Human Organs Act (THOA), 1994, and patient/surrogate documented informed refusal, following prognostic awareness, to continue life support, have been mentioned in the draft.
The Union ministry has invited feedback and suggestions by the mid of next month.
The Terminal illness in the draft guidelines has been defined as an irreversible or incurable condition from which death is inevitable in the foreseeable future. “Severe devastating traumatic brain injury which shows no recovery after 72 hours or more is also included.”
The guidelines also address Do-Not-Attempt-Resuscitation (DNAR) decisions, stating that a considered decision not to perform cardiopulmonary resuscitation (CPR) may be made if there is no realistic chance of survival or meaningful recovery.
The draft stated that the legal principles outlined by the Supreme Court state an adult patient capable of taking healthcare decisions may refuse LST even if it results in death, LST may be withheld or withdrawn lawfully under certain conditions from persons who no longer retain decision-making capacity, based on the fundamental right to Autonomy, Privacy and Dignity, Advance Medical Directives (AMD) that meets specified requirements is a legally valid document.
The guidelines also stated that for a patient without capacity, Foregoing of Life Support FLST proposals should be made by consensus among a group of at least 3 physicians who form the Primary Medical Board (PMB).
The PMB must explain the illness, the medical treatment available, alternative forms of treatment, and the consequences of remaining treated and untreated to fully inform the surrogate 6. A Secondary Medical Board (SMB) of 3 physicians with one appointee by the Chief Medical Officer (CMO) of the district must validate the decision by the PMB.
“Active Euthanasia is the intentional act of killing a terminally ill patient on voluntary request, by the direct intervention of a doctor for the purpose of the good of the patient. It is illegal in India,” the guidelines said. In 2018, the Supreme Court had allowed passive euthanasia.
(With inputs from ANI)