Supreme Court ruling on end-of-life care: Experts demand fresh legislation by government

The Supreme Court ruling on end-of-life care has been widely hailed by medical fraternity but the "impractical mechanism" laid down to implement it has also led to demands of a new legislation.

NEW DELHI: The Supreme Court ruling on end-of-life care has been widely hailed by medical fraternity but the "impractical mechanism" laid down to implement it has also led to demands of a new legislation by the government so that the law is executed easily.

Last week, the top court passed a judgment upholding the legality of withholding or withdrawing life supporting medical intervention from terminally ill patients. It however, said that a two step process be followed—including vetting by a term of doctors, permission by the district court or magistrate-- before a decision is taken on foregoing life support in critical cases.

Many critical care experts however pointed out that the legal recognition of this act, referred as “passive euthanasia” in the judgement, is not new.

“A previous judgment by the Supreme Court made it legally permissible since 2011 Aruna Shanbaug case,” said Raj K Mani, an impleader in the PIL by the NGO Common Cause in which the ruling has come. “Now, the Supreme Court has gone further in confirming the right to a dignified death as a part of the right to life under article 21 of the Indian Constitution.”

He added that the 2011 ruling had a major shortcoming in its requirement to seek the permission of the High Court every time life-sustaining medical treatment was to be withheld or withdrawn from a terminally ill patient.

“In fact because of that, not a single case reached the high court even as most cases of withholding or withdrawal of medical treatment for terminally ill patients are routinely decided outside of court,” said Mani who is also the chairperson of End-of Life Care in India Task Force.

“We will therefore engage with the government so that a more practical legislation is put in place soon which allows doctors and families to take these sensitive decisions quickly.”

Rajesh Pande, Joint secretary of the Indian Society for Critical Care Medicine said that the SC verdict on end-of-life care was a major progressive step but also an “overtly legal one.”

“People laying down these rules must understand the sensitivity of the situation. For instance, when a kin is very critical and beyond chance of return, no family member will want to approach a district court to seek permission on whether the life support can be withheld or not.”

Pradip Bhattacharya of the ISCCM said that such situations are not only tough for families but for doctors too. “Lawmakers should therefore take into account these factors and simplify the process so that a good judgement is also executed properly.”