Credit: Special Arrangement
Many hospitals in Bengaluru are setting up committees to implement ‘the right to die with dignity’. They expect the committees to be functional by next month.
Karnataka is the first state to adopt the Supreme Court’s direction to allow ‘the right to die with dignity’.
In late January, the Karnataka government said it would provide the right to terminally ill patients with no hope of recovery. It also instructed hospitals to form two committees to suggest such patients to the judiciary – ‘the right to die with dignity’ requires a court order.
Some hospitals are waiting for detailed instructions, while others are in the process of setting up committees.
‘Best practices’
Dr Radheshyam Naik, consultant medical oncologist, hematologist and bone marrow transplant physician with Sammprada Hospital, says his hospital’s committee will include two doctors (one internal and one from another hospital), a lawyer, and a female social worker.
Though new to India, the right to die with dignity is common in countries like The Netherlands, and their hospital plans to adopt their best practices. “The doctors on the committee could be intensivists, ICU specialists, oncologists, anesthetists and physicians,” he says.
Dr Sunil Karanth, chairman and consultant (critical care medicine), Manipal Hospital, Old Airport Road, says the right to die with dignity has come about after long years of discussion.
“The primary medical board will include the primary doctor treating the patient, and two other subject expert doctors with at least five or more years of experience in their specialities. The secondary medical board will include three other doctors (who are not part of the primary board) from the same institution with five or more years of experience, including one from the hospital, selected by the district health officer,” he says.
The order from the state government notifies that the nominated member from the District Health officer could be any of the doctors empanelled with the state’s brain stem declaration committee.
“Our committee should be ready by April. We will provide basic training to our doctors to understand the legalities and the protocol,” he says.
Once the primary board comes to a consensus with the patient’s caregivers on the decision to withdraw life sustaining treatment, the secondary board will need to give its decision within 48 hours, he explains.
Legal challenges
Dr Harish Reddy, group medical director, HCG Hospitals, says, “Our hospitals will need to intensively train doctors to understand the legal aspects.”
“As we work towards forming a team, we want them to be aware of the importance of prognostication and the importance of the family’s consent,” he told Metrolife.
In case of comatose patients, no family member should be able to take advantage of the situation. Also, the team will be trained to handle conflicts which arise when a family member is not aligned with the decision of the primary family member or caregiver, he says.
The HCG panel will be multidisciplinary and include oncologists, intensivists, and palliative care specialists. “A list should be ready in two weeks. The committee should be ready by April end,” he says.
‘Counselling a must’
Dr B L Sujatha Rathod, director of medical education, Karnataka, says emotional and legal aspects should not be neglected.
“Counselling the family which allows its kin to be taken off life support is needed. Assuring and reassuring them and getting a well-informed consent should be focused on. Grief counsellors or psychologists can also help the family understand organ donation,” she says.
Taking a person off life support calls for decisions such as “determining at what stage a person should be taken off the ventilator”. “Mutiple expert opinions should be considered. It is also important to document all these steps on written and video recordings,” she says.
Minister says…
Health Minister Dinesh Gundu Rao on January 31 posted on X that hospitals must set up the primary and secondary medical boards, comprising three registered medical practitioners each, to implement the right to die with dignity.
“The secondary medical board must have a registered medical practitioner nominated by the District Health Officer,” his post said.
What’s allowed
Withdrawal of life support under certain circumstances, is now legal in Karnataka.
Active euthanasia, or the act of ending a patient’s life with the administration of a lethal substance, is not allowed in India. It is a criminal offence.