‘Individuals have a right to die with dignity’

The sensitive subject of an individual’s right to choose end-life medical care came up for elaboration and discussion at a well-attended session last week. Individuals can exercise this right by executing an Advance Medical Directive (AMD). In 2018, during the Aruna Shanbaug case, the Supreme Court recognised the concept of passive euthanasia and laid down guidelines about the content of AMD and how to execute it. A nurse hailing from Karnataka, Aruna spent over 41 years in coma following a
sexual assault.

“AMD is an extension of the right to life guaranteed under Article 21. It recognises the right to die with dignity,” said Shiv Kumar, who delivered the public talk at Bangalore International Centre, Domlur. He is a senior advocate with Karnataka High Court. He has been fighting for elder rights for 20 years.

AMD specifies the treatment a person is willing to receive or decline under circumstances where there is no hope of recovery. The person also needs to name guardian/s or close relative/s to make this decision when they are unable to do so. “For example, a person can choose to withhold life support,” said Kumar.

AMDs can be executed by anybody above the age of 18 as long as one is in a sound state of mind and body. The primary requirement is that they should be making an “informed choice”. Like property wills, it is advisable to write AMDs in younger years, he said, adding you can change the contents of the AMD over time.

Since the AMD is a legally enforceable document, he said it is preferable for individuals to approach lawyers to draft it. AMD doesn’t apply to organ donation or cadaver donation or psychiatric cases.

However, practical challenges remain. “How much time can medical professionals give you to explain the canvas of treatment you may be subjected to? How do you make an informed choice? Then there is the guilt of ‘pulling the plug’,” he shared. “The sheer effort” can also put off people — two independent witnesses (advisably younger) are needed to execute an AMD, and implementation can take six months. He believes these issues can be addressed with well thought-out legislation but we first need to change social attitudes. “Talking about death is taboo in our society,” he said.

He has drafted 20-odd AMDs. “These clients understand the financial implications of critical care. They have seen others suffer and don’t want to burden their families. They don’t want to endure the suffering,” he shared. In most of these cases, children live away from their ageing parents.

The talk was organised by Silver Talkies, a community platform for people aged 55 and above. Its CEO and cofounder, Nidhi Chawla, recalled an elderly woman and her two children who worked actively to get an AMD done for her last year. She said, “The mother has early onset dementia. She lives in Bengaluru while the children stay in different countries.”