Risks aplenty with mercy death verdict

In a landmark judgement recently, the Supreme Course legalised passive euthanasia by giving sanction to 'Advance Directive' or 'Living Wills'. In layman's words, this gives people the right to a 'living will' on withdrawing medical support if they slip into an irreversible coma.

Doctors across the country have been flooded with questions about the verdict. Metrolife spoke to doctors, many of whom see this as a positive step, especially for oncology and intensive-care related cases.    

Dr Baswantrao Malipatil, an oncologist with Columbia Asia Hospital, feels this is a turning point in medical history in the country. "It's a good move for cancer patients. Unlike accident cases, where intensive care unit can often help patients recover and get better when their body heals, in cancer, one knows there is no cure," he says.

During counselling sessions for cancer patients, they are told about the option of escalation of treatment, points out Dr Baswantrao. "Escalation of treatment means being put on life-support system which leads to progression of the condition," he adds.   "Often the patient and relatives are confused about medical conditions. Most of the patients even if terminally ill will be in a condition to take a decision to carry treatment ahead or not and this judgement helps at such points," he says.    

This judgement helps one to determine if they want to go ahead with invasive treatments which are more intense compared to painkillers, medicines for disturbed sleep and for conditions like constipation etc will continue if needed," says Dr Baswantrao.

Dr Jagadish Chikkegowda, senior consultant, critical care, has often hoped for this judgement to come through, during his 11 years service. "Any case which is non-treatable and continues to progress deserves this respectful judgement. The many cases this applies to include advance malignancies and progressive degenerative condition. It is also applicable for hypoxic brain injury (that happens after cardiac arrests)  cases which is less likely to get neurological recovery but can continue to survive with support," he says.

"Since it is an irreversible process, the decision needs to be taken in a stable state of mind. Also, the law clearly needs to state who will be the person of authority when a patient slips into an irrecoverable state. There are often times when children contest the decision and this needs to be chalked out," adds  Dr Jagadish Chikkegowda.

Number of cases

Dr Jagadish Chikkegowda sees about 15 to 25 cases every year where passive euthanasia might help. "Any cases where the quality of life comes into question is where this judgement helps," he adds.

What can go wrong

When the patient gives an oral consent and does not give a written statement.
When proper documentation is not in place. In many cases, relatives of the patient want the patient to be put on life-system till family members are together.

Determining the mental condition of a patient when such a decision is taken. A psychiatrist might be needed to certify that the patient is mentally stable when the documentation is in process.

Determining that the patient is not under any pressure.

Clear laws about who will be the next in charge in the family if a decision has to be taken.