Wednesday 17th July, TOI Mumbai edition carried a headline “SC wants euthanasia debate, seeks states’ views in 8 wks”

The concept of Euthanasia, which has been assigned to back benches for decades, has once again surfaced and by none other than the Apex court of the country.

Lifecountz approached Dr C H Asrani, who with his added qualification in forensic medicine (legal side of medicine) was requested to simplify what all the debate was about.

What is euthanasia?

The term Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering.

Passive euthanasia: implies withholding of common life support treatment modalities, such as ventilators, necessary for the continuance of life, with consent of next of kin.

Active euthanasia: implies use of lethal substance (administering a fatal injection), triggering a cardiac arrest.

What is global opinion?

Jurisdictions where euthanasia or assisted suicide is legal include the Netherlands, Belgium, Luxembourg, Switzerland, Estonia, Albania, the US states of Washington, Oregon and Montana and starting in 2015, the Canadian Province of Quebec.

Why this debate about euthanasia?

With advances in medicine in general and critical care in particular and application of technology in healthcare, there has been a sharp surge in advanced life support systems/ medications, which support deteriorating important bodily systems/ organs viz heart, lungs, kidneys etc. It so happens that a critically ill patient is put on advanced life support systems with expectation of recovery and despite reaching a point of no return (treating doctor ruling out any possibility of the patient recovering) the life support system cannot be switched off.

Family members are known to have sold / mortgaged property, jewelry, investments to pay the hospital bills knowing very well that it is of no use.

The debate is about the rights of a terminally-ill patient after the treating doctors have ruled out any chances of survival. Today, when the next of kin is required to give consent to put the patient on a ventilator; why the same next of kin cannot give in writing to withdraw advanced life support system?

How this can be accomplished?

The judiciary should allow any person(s) to execute a different kind of will, in sound mind and in full control of his/her mental faculties, saying if he or she ever slipped into a vegetative state with a terminal disease with no chance of recovery, doctors shouldn’t keep him or her alive with the help of life support. Such a final testament should be attested by two credible witnesses and may/ may not be registered with a magistrate.

There may also be an addendum – DNR (Do Not Resuscitate). Whenever a person in a vegetative state/ terminal state gets a cardiac arrest he/ she is subjected to Cardio Pulmonary Resuscitation and in a large percentage of cases, it saves the patient (prolong the vegetative state). Such a proclamation will prevent the treating doctor from trying resuscitative attempts.

But what about malpractices?

As that is a worry! Malpractices will happen but checks can be planned. As any will and testament done by any person, in sound mind, is accepted by judiciary; a law can be enacted to ensure acceptance of such a will with necessary caution.

In cases, where such a will is not in existence and the person reaches a vegetative state, a law can enacted that necessitates at least three (3) doctors certifying a request put in by three (3) blood relations (including spouse).

Let us first start by passive euthanasia and observe the results; fine tune in as time goes by. Once it is made fool proof, in a decade or two, active euthanasia may be considered.

Dr Chander Asrani, is a post-graduate in Family Medicine. He has over 36 years in family practice and has witnessed several kids going awry because father was just a shadow in their life. He writes on various subjects of wellness; learning to live with chronic ailments and stress. Know more about him at about.me/drasrani.