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The Andhra Pradesh government on Wednesday, July 8 issued guidelines for passive euthanasia, in line with Supreme Court directives. Passive euthanasia, commonly referred to as withdrawal of life-sustaining treatment, is legally permitted in India in certain circumstances. The Supreme Court has held that medical interventions such as ventilators or feeding tubes may be withdrawn in cases where a patient is terminally ill or in a persistent vegetative state with no hope of recovery.
In 2018, in the Common Cause vs Union of India ruling, the SC held that the right to die with dignity forms part of the fundamental right to life under Article 21 of the Constitution. Through subsequent clarifications in 2023, it laid down detailed procedures, including review by medical boards, for withdrawal of life-sustaining treatment.
In March this year, the Supreme Court for the first time ever allowed the withdrawal of life support to Harish Rana, a 32-year-old who had been in a permanent vegetative state for 13 years since he suffered a fall from a building.
What do Andhra’s passive euthanasia guidelines say?
Andhra Pradesh Health Minister Satya Kumar Yadav approved the following guidelines for passive euthanasia, providing legal validity to decisions on passive euthanasia made by patients, doctors, and patients’ family members.
> A patient, while fully conscious and acting independently, free from coercion, may draft and sign an Advance Directive (a living will) in the presence of two witnesses. The Advance Directive must designate a guardian authorised to make appropriate decisions regarding future medical treatment based on circumstances. The document must be attested by a notary or a gazetted officer.
> If the attending doctor assesses that a patient has reached the terminal stage and is unresponsive to treatment, and concludes—based on the decision outlined in the Advance Directive—that it is best to discontinue ongoing treatment, they must explain this to the designated guardian. Similarly, if initiating treatment is deemed futile, the guardian must be informed of this assessment.
> In such circumstances, the hospital authorities must constitute a Primary Medical Board comprising the patient’s attending doctor and two other doctors with at least five years of experience, to evaluate the terminal patient’s condition and arrive at a preliminary decision within 48 hours.
> If the Primary Medical Board deems that providing treatment to the patient is futile, a Secondary Medical Board must be constituted, comprising the attending doctor, the District Medical and Health Officer (DMHO), and two other doctors not involved in the patient’s treatment.
> Before discontinuing treatment, the hospital authorities must inform the First Class Judicial Magistrate of the opinions of both medical boards and the guardian’s consent.
> If the Secondary Medical Board does not agree to discontinue the patient’s treatment, the guardian designated by the patient may approach the High Court. The High Court will then constitute an independent committee consisting of doctors with at least 20 years of experience.
What happens if the patient hasn’t signed an Advance Directive before their condition worsens?
> The attending doctor must inform the hospital authorities about the patient’s condition, and a Primary Medical Board will be constituted. This board will thoroughly explain to the patient’s relatives the consequences of withholding or withdrawing treatment and document these details in writing.
> Subsequently, a Secondary Medical Board will be formed. In case of any difference of opinion, the patient’s relatives may approach the High Court.
> If life support is ultimately withdrawn from the patient, the concerned Magistrate must inform the High Court of the matter.
> Records pertaining to the process followed in passive euthanasia cases must be preserved for three years following the patient’s death.