The Supreme Court has delivered a landmark judgment for patients facing terminal illness. Such patients and their families are often subjected to unwanted medical interventions that serve only to render the dying process agonising. Medical ethics and standards in such circumstances involve offering the choice of withholding or withdrawing such interventions while shifting the focus of care to providing comfort.
Autonomy is a fundamental right and since such a right is unconditional, it should extend to the time when the patient is incompetent. This judgment reiterates such a right to all in relation to their bodily and personal integrity while facing death.In the wake of the Aruna Shanbaug judgment, this meant going through a complicated court procedure when the patient was incompetent. Such a provision was practically impossible to implement. The Law Commission in its 196th and 241st reports pronounced advance will as invalid.
In a departure from this position, the present judgment has declared that in keeping with the Gian Kaur judgment that interpreted Article 21 as the right to die with dignity, no further legislation is needed. It goes on to state that the principle of autonomy requires that the instruments advance directive and appointment of a healthcare proxy are constitutionally valid.
To correct this anomaly the ICMR has created a document called “Definition of terms used in limitation of treatment and providing palliative care at end of life” due for publication.The medical profession has been seeking a constitutional and legal framework to practice end-of-life palliative care that is ethical, rational and humane.
The writer is with the Nayati Group of Hospitals and an impleader in the current writ petition