The Indian Council of Medical Research (ICMR) is soon set to finalize principles that will guide physicians on whether to perform cardio-pulmonary resuscitation (CPR) and put the patient on a ventilator if he has an incurable disease where the survival chances are slim. Now, MCI ethics rule 6.7, which deals with euthanasia, is the legislation applicable to whether or not to pull the plug on a terminally ill patient. This says the practice of euthanasia is unethical behavior. Nevertheless, on specific occasions, the question of removal of supportive devices for preserving cardio-pulmonary resuscitation function even after brain death should be determined only by a team of doctors and not solely by the treating doctor. This is an ethical issue for both family members and physicians.
A medical team shall announce the removal of the support system and shall consist of the patient’s doctor in charge, the hospital’s chief medical officer / medical officer and a doctor named by the staff in charge of the hospital or in accordance with the provisions of the 1994 Human Organ Transplantation Act.
A Supreme Court Constitutional Bench headed by CJI Dipak Misra in Common Cause versus Union of India, 2018, held that an Advance Medical Directive (AMD) would serve as a good way to promote the of the enshrined right in the constitution to dignified life, therefore describing about Cardio-pulmonary resuscitation . The judgment listed AMD’s various protections and protocols, including who should conduct it and its details. Some of the security measures are:
- In the event that the individual is terminally ill and receives extensive medical treatment without any hope of recovery and cure, the treating physician shall check its validity and legitimacy from a first-class judge before proceeding on the same.
- The doctors must give proper weight to the directions in the paper. Nonetheless, this should only take effect after it is fully confirmed by the doctor that the patient is terminally ill and receiving extended care or living on ventilator and that his condition is not treatable or there is no hope that he will be healed.
- If the doctor treating the patient is assured that the directions provided in the document must be followed, the executor or his guardian / close relative shall be advised of the nature of the disease, the availability of medical care and alternative forms of treatment, and the implications of staying untreated. He should also ensure that, on reasonable grounds, he believes that the person in question understands the information provided, has considered the options and has come to a firm view that the best choice is to withdraw or refuse medical treatment.
- The physician/hospital where the executor has been admitted for medical treatment shall then constitute a medical board consisting of the head of the treating department and at least three experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology with experience in critical care and with overall standing in the medical profession of at least 20 years. They, in turn, shall visit the patient in the presence of his guardian /close relative and form an opinion whether to certify carrying out the instructions of withdrawal or refusal of further medical treatment. This decision shall be regarded as a preliminary one.
The amended declaration describes euthanasia as “a doctor intentionally administering a lethal drug or conducting an operation to cause the death of a patient with decision-making ability on a voluntary request of the patient.” It says that doctor-assisted suicide “refers to cases in which, at a patient’s voluntary request with decision-making capacity, a physician deliberately allows a patient to end his or her own life by prescribing or supplying medicinal substances intended to cause death.”