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SC Allows ‘Living Will’ Of Terminally Ill Persons

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  • SC allows living will for the terminally ill patients
  • SC says the person has ‘right to die with dignity’
  • In a living will, a  person can choose not to prolong his or her life using artificial means

The Supreme Court on Friday said a person has the “right to die with dignity” and can make an advance “living will” authorising the withdrawal of life support system if in medical view he has reached an irreversible stage of terminal illness.

While allowing a person to make the advance directive or living will, a five-judge Constitution Bench headed by Chief Justice Dipak Misra, however, attached strict conditions for executing the “will” made by a person in his normal state of health and mind.

Supreme court give terminally ill patients the 'living will''
Supreme court give terminally ill patients the ‘living will”

In the living will, a person can state in advance that his or her life should not be prolonged with a ventilator or artificial support system. The bench, also including judges A.K. Sikri, A.M. Khanwilkar, D.Y. Chandrachud and Ashok Bhushan, laid down guidelines on who would execute the will and how the nod for passive euthanasia would be granted by the medical board.

Recognising the “right to die with dignity”, the court permitted a person to draft in advance a living will in case she/he slips into an incurable condition. “To deprive an individual of dignity at the end of life is to deprive him of meaningful existence,” said Justice Chandrachud while allowing the living will for passive euthanasia.

Also Read: Ethical Dispute Erupts Over Euthanasia Rules

The court said the life support can be removed only after the statutory medical board declares the patient to be incurable. The bench said its guidelines and directives should remain in force till a legislation was brought to deal with the issue.

“Life and death are inseparable. Bodies involve continuous change but mind remains constant… Death represents culmination of life… Freedom, liberty are core of meaningful life,” Justice Chandrachud said. The court pronounced four separate but concurring judgements.

The person will have right to not prolong his or her by using artificial means. Wikimedia Commons
The person will have right to not prolong his or her by using artificial means. Wikimedia Commons

The court’s verdict came on a plea filed in 2005 by an NGO Common Cause seeking the right to make a living will authorising the withdrawal of life support system in the event of the will-makers reaching an irreversible vegetative state.

Advocate Prashant Bhushan, appearing for the NGO, had said that since a patient under coma cannot express his/her wish, law should allow him/her to put it down in writing in advance that he/she should not be tortured. In the absence of a law authorising doctors to do so, they keep incurable patients on life support, he said. IANS

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Ethical Dispute Erupts Over Euthanasia Rules

Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised certain concerns

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An Euthanasia machine, should be used by those who want to use it. Wikimedia Commons
An Euthanasia machine, should be used by those who want to use it. Wikimedia Commons
  • Euthanasia has always been a controversial topic
  • Belgium is one of the few countries where the practice is allowed
  • However, despite that many citizens can’t avail the right to take over their own life

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case was described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Euthanasia is legal in Belgium since 2002. Wikimedia Commons
Euthanasia is legal in Belgium since 2002. Wikimedia Commons

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be euthanized came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia.

Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised concerns in recent months about certain practices, including how quickly some doctors approve requests to die from psychiatric patients.

Dispute revealed

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Also Read: 3 Cups of Coffee a day may Prevent you from Premature Death

Euthanasia — when doctors kill patients at their request — can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be “unbearable and untreatable.” It can be performed only if specific criteria are fulfilled, including a “voluntary, well-considered and repeated” request from the person.

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Dr. Lieve Thienpont is an advocate of euthanasia for the mentally ill. VOA
Dr. Lieve Thienpont is an advocate of euthanasia for the mentally ill. VOA

The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont’s patients might have been killed without meeting all the legal requirements. Prompted by the AP’s reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Euthanasia — when doctors kill patients at their request — can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be “unbearable and untreatable.” It can be performed only if specific criteria are fulfilled, including a “voluntary, well-considered and repeated” request from the person.

But Belgium’s euthanasia commission routinely violates the law, according to a September letter of resignation written by Dr. Ludo Vanopdenbosch, a neurologist, to senior party leaders in the Belgian Parliament who appoint members of the group.

The most striking example took place at a meeting in early September, Vanopdenbosch wrote, when the group discussed the case of a patient with severe dementia who also had Parkinson’s disease. To demonstrate the patient’s lack of competence, a video was played showing what Vanopdenbosch characterized as “a deeply demented patient.”

The patient, whose identity was not disclosed, was euthanized at the family’s request, according to Vanopdenbosch’s letter. There was no record of any prior request for euthanasia from the patient.

After hours of debate, the commission declined to refer the case to the public prosecutor to investigate whether criminal charges were warranted.

Euthanasia should be allowed to die when they want to. VOA
Euthanasia should be allowed to die when they want to. VOA

Vanopdenbosch confirmed the letter was genuine but would not comment further about details.

Palliative sedation

The two co-chairs of the euthanasia commission, Distelmans and Gilles Genicot, a lawyer, said the doctor treating the patient mistakenly called the procedure euthanasia, and that he should have called it palliative sedation instead. Palliative sedation is the process of drugging patients near the end of life to relieve symptoms, but it is not meant to end life.

“This was not a case of illegal euthanasia but rather a case of legitimate end-of-life decision improperly considered by the physician as euthanasia,” Genicot and Distelmans said in an email.

Vanopdenbosch, who is also a palliative care specialist, wrote that the doctor’s intention was “to kill the patient” and that “the means of alleviating the patient’s suffering was disproportionate.”

Though no one outside the commission has access to the case’s medical records — the group is not allowed by law to release that information — some critics were stunned by the details in Vanopdenbosch’s letter.

Also Read: Is the Jain practice of Sallekhana really suicide?

“It’s not euthanasia because the patient didn’t ask, so it’s the voluntary taking of a life,” said Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. “I don’t know another word other than murder to describe this.”

Kristof Van Assche, a professor of health law at the University of Antwerp, wrote in an email the commission itself wasn’t breaking the law because the group is not required to refer a case unless two-thirds of the group agree — even if the case “blatantly disregards” criteria for euthanasia.

But without a request from the patient, the case “would normally constitute manslaughter or murder,” he wrote. “The main question is why this case was not deemed sufficiently problematic” to prompt the commission to refer the case to prosecutors.

Other problems

Vanopdenbosch, who in the letter called himself a “big believer” in euthanasia, cited other problems with the commission. He said that when he expressed concerns about potentially problematic cases, he was immediately “silenced” by others. And he added that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity.”

Vanopdenbosch wrote that when cases of euthanasia are identified that don’t meet the legal criteria, they are not forwarded to the public prosecutor’s office as is required by law, but that the commission itself acts as the court.

Patients suffering from psychological disorders should be allowed euthanasia. Pixabay
Patients suffering from psychological disorders should be allowed euthanasia. Pixabay

In the 15 years since euthanasia was legalized in Belgium, more than 10,000 people have been euthanized, and just one of those cases has been referred to prosecutors.

Genicot and Distelmans said the group thoroughly assesses every euthanasia case to be sure all legal conditions have been met.

“It can obviously occur that some debate emerges among members, but our role is to make sure that the law is observed and certainly not to trespass it,” they said. They said it was “absolutely false” that Vanopdenbosch had been muzzled, and they said they regretted his resignation. VOA