When med care fails: What SC’s passive euthanasia ruling means | India News

In a landmark ruling that revisits one of medicine’s toughest ethical questions, the Supreme Court on Wednesday allowed the withdrawal of artificial life support — or passive euthanasia as it’s commonly referred to — for a 31-year-old man who had been comatose for more than 13 years. The decision in the Harish Rana case was the first time that a court directly allowed passive euthanasia for a patient in a persistent vegetative state. Dr. Sushma Bhatnagar Former head of AIIMS and professor of onco-anesthesia and palliative medicine, said TOI What this means in medical practice and how doctors decide when life support should be withdrawn.What does passive euthanasia mean in medical practice?Simply put, it involves withdrawing life support, stopping certain artificial aids that prolong life without improving the patient’s condition. For example, doctors may stop artificial feeding, fluids or other life-sustaining interventions when they are no longer beneficial. The goal is not to actively end life, but to stop treatment that only prolongs suffering, and allows the illness to run its course when recovery is not possible.Under what circumstances do doctors consider withdrawing life support?Doctors consider it when the treatment no longer helps the patient and only increases the suffering. In such cases, continued aggressive medical support may not be in the patient’s best interest. Circumstances may include a permanent vegetative state, severe and irreversible brain injury, terminal cancer, end-stage renal failure where dialysis is no longer effective, or advanced heart disease where treatment options have been exhausted. This may involve withdrawal of ventilatory support, discontinuation of drugs that artificially maintain blood pressure, dialysis, artificial feeding through a tube, or other interventions to maintain physical activity without improvement in the patient’s condition.

How do doctors determine that a patient has no chance of recovery and what safeguards should be followed before withdrawing life support in India?There are established medical criteria and tests. For example, specific equipment is used to confirm conditions such as coma or vegetative state. In terminal illnesses such as advanced cancer, prognosis and chances of recovery are assessed using evidence-based treatment guidelines. In India, decisions are usually reviewed by a primary and a secondary medical board before a decision is made. In some cases, hospital ethics committees may also be involved to ensure that the process adheres to medical ethics and legal guidelines laid down by the Supreme Court. These measures ensure that the decision is medically justified and ethically correct.How important is a living will or advance directive?They are extremely important. If a patient clearly states in advance what type of treatment they want or do not want in such a situation, doctors and families can follow those wishes. Respecting patient autonomy is a fundamental principle of medical ethics.How often do doctors get requests to withdraw life support in India?It is still relatively rare in India.Awareness of advance directives is limited. Culturally, many families struggle to accept death as a normal part of life.What is the difference between active and passive euthanasia and how does the latter differ from assisted suicide or assisted dying?Active euthanasia involves the intentional administration of drugs to cause death. Passive euthanasia refers to the withdrawal or withholding of treatment that artificially sustains life and the discontinuation of medical interventions that are no longer beneficial. Assisted suicide involves actively helping a person end their life, usually by providing medication that the person takes himself.What are some common misconceptions about passive euthanasia?Many believe this means doctors are actively trying to end the patient’s life. In practice, it usually involves stopping medical interventions that are no longer useful, and focusing on comfort, care and dignity at the end of life.From a medical ethics perspective, why are these practices treated differently?Medical ethics emphasizes doing no harm and avoiding treatments that do no good. When treatment only prolongs suffering with no realistic chance of recovery, withdrawal may be considered morally appropriate.