Karnataka implements guidelines to allow terminally ill patients 'right to die with dignity'

This follows the Supreme Court’s ruling from January 24, 2023, which allows the withdrawal of life support when a patient has no chance of recovery or is in a persistent vegetative state.
Image used for representation only.
Image used for representation only.(File Photo)
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BENGALURU: The Karnataka government has issued orders to implement the Supreme Court’s directive regarding a patient’s Right to Die with dignity.

In the orders issued on Thursday, the health department appointed medical experts to the Secondary Medical Board to decide when life-sustaining treatment can be stopped for terminally ill patients.

This follows the Supreme Court’s ruling from January 24, 2023, which allows the withdrawal of life support when a patient has no chance of recovery or is in a persistent vegetative state. Karnataka is now the second state, after Kerala, to implement this ruling.

This ruling specifically applies to patients who have been undergoing long-term treatment with no hope of improvement, or to those in a vegetative state, where medical treatment would only harm them rather than help them.

The government has also introduced an Advanced Medical Directive (AMD), or living will, in which a patient can record their wishes regarding future medical treatment.

Under the new order, any neurologist, neurosurgeon, surgeon, anaesthetist, or intensivist already approved to certify brain-stem death under the Transplantation of Human Organs and Tissues Act, 1994, will also be eligible to serve on the Secondary Medical Board. District Health Officers (DHOs) across Karnataka will automatically recognise these doctors for this role.

Health Minister Dinesh Gundu Rao said, “This order will be a great relief for those who are terminally ill, have no hope of recovery, or are in a persistent vegetative state, where continuing treatment no longer helps.” He also mentioned that this decision would provide families and individuals with a dignified sense of closure.

Procedure for withholding treatment

The order outlines a step-by-step procedure for withholding life-sustaining treatment. First, the treating doctor must approve the decision. After that, the hospital where the patient is being treated needs to set up two medical boards – a Primary Medical Board and a Secondary Medical Board. Each board will consist of three registered medical practitioners.

The Secondary Medical Board must include a doctor nominated by the DHO. Both boards will carefully consider whether withholding treatment is the right choice, after consulting the patient’s family or the person named in the patient’s AMD.

Before any action is taken, the decisions of both boards must be submitted to the Judicial Magistrate of the First Class (JMFC). The JMFC will review the decision and send copies to the High Court Registrar for official record-keeping.

What is an Advance Medical Directive (Living Will)?

An AMD, or living will, is a document where a patient can state their wishes about the type of medical treatment they want or do not want in the future. If a patient becomes unable to make decisions later, they can appoint two trusted individuals to make decisions on their behalf.

Any mentally sound adult patient can create an AMD. Once made, the patient should give a copy of the directive to a government-appointed officer. Additionally, the AMD can be added to the patient’s health records, whether digital or paper, which are kept by the medical facility treating the patient.

The Health Department explained that having an AMD helps doctors understand the type of treatment the patient wants, or would like to avoid, ensuring that the patient’s wishes are respected when the time comes.

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