In its 24 January 2023 judgement, the Supreme Court noted that the right to life guaranteed under Article 21 of the Constitution encompassed the right to die with dignity as well.
Published Jan 31, 2025 | 1:36 PM ⚊ Updated Jan 31, 2025 | 2:45 PM
Life-saving treatment provided to terminally-ill patients with no hope of recovery could be withdrawn based of certain norms. (Wikimedia Commons).
In a significant move, the Karnataka Health Department has issued an order to implement the Supreme Court’s order allowing terminally ill patients to die with dignity.
The order would allow the withholding or withdrawal of life-saving treatment for patients with no hope of recovery.
Announcing the passing of the order, Karnataka’s Health Minister Dinesh Gundu Rao said, “This will immensely benefit those who are terminally ill with no hope of recovery, or are in a persistent vegetative state, and where the patient no longer benefits from life-sustaining treatment.”
The department had also come out with an Advance Medical Directive (AMD), or a ‘living will’, in which a patient could record their desired medical treatment in the future.
“This important step will bring great relief and a dignified sense of closure to many families and individuals,” Rao said on X.
Incidentally, Karnataka is the second state after Kerala to implement the Supreme Court directive.
The Karnataka Health Department’s order mentioned the Supreme Court’s 24 January 2023 judgment that the right to life guaranteed under Article 21 of the Constitution encompassed the right to die with dignity.
“To enable a dignified death, it (the court) has held that life-sustaining treatment may be withheld or withdrawn where the patient is terminally ill with no hope of recovery, or is in a persistent vegetative state, and where the patient no longer benefits from life-sustaining treatment,” the order said.
The Supreme Court had stated that WLST would be appropriate for terminally-ill patients, undergoing prolonged medical treatment with no hope of recovery and cure of the ailment.
“This may be the case for those who are in a persistent vegetative state and when certain kinds of medical treatment may no longer provide any reasonable possibility of benefit, and may instead, have a greater potential to cause harm to the patient,” Karnataka’s order said.
The state would follow the procedure the Supreme Court had laid down for WLST. The treating doctor should approve WLST. The hospital where the patient is being treated must set up primary and secondary medical boards, comprising three registered medical practitioners each.
“The secondary medical board must also have a registered medical practitioner nominated by the District Health Officer. The primary and secondary medical boards will take decisions regarding WLST after obtaining the consent of the patient’s next of kin or the person nominated in the patient’s advance medical directive,” the health department said.
Further, copies of the two boards’ decisions on WLST must be submitted to the Judicial Magistrate of the First Class (JMFC) before giving effect to the them, and the JMFC will send copies to the Registrar of the High Court for record-keeping,” the state order added.
An advance medical directive (AMD) — or a living will — is a document in which a patient could record his/her wishes about future medical treatment. The patient could also nominate two persons to decide on his/her behalf if the patient does not have decision-making capabilities.
The AMD would indicate to healthcare providers the kind of treatment the patient wants or prefers to avoid.
“Any adult patient of sound mind can execute an AMD and should send a copy of the AMD to a competent officer who is to be appointed for this purpose by the local government. AMDs can also be maintained in the paper/digital health records of the patient which are maintained by the medical establishment,” the health department said.
Medical practitioners welcomed Karnataka’s move.
I always wanted this bill to be effective. It’s the family members who are reluctant to let go especially if the children are abroad and if they are doctors. I have already mentioned in my joint will with my spouse that no active invasive intervention is needed when terminally ill and the body must to be donated to medical research, after utilising possible organs,” Dr Sundar Sankaran, Nephrologist and Director of Aster Institute of Renal Transplantation in Bengaluru said.
“No one should die alone in the ICU without family and friends,” he added.
Dr Rajani Surender Bhat, Interventional Pulmonologist and Palliative Medicine physician at Sparsh Hospitals, Rajarajeshwari Nagar, said she had witnessed several families suffering from inappropriate end-of-life care, which can come with a financial burden as well.
“I welcome the Karnataka government’s initiative in establishing a clear pathway for patients and families to work with doctors and administrators, dealing with complex ethical dilemmas, easing the process of advance care planning as well the withdrawal and withholding of organ-support services in ICUs when they are no longer beneficial,” she said.
Dr Nitin Yashas, Medical Oncologist at Manipal Hospitals said with advances in cancer therapeutics stage 4 cancer patients frequently survive longer.
“However, we do encounter circumstances wherein there are patients whose general condition is poor and are unlikely to tolerate treatment or those in whom cancer has progressed rapidly and all available treatment options have been exhausted. In such situations, the option of withdrawing/withholding support goes a long way in providing autonomy to the patient and families and the treating team to shift the focus to palliative and comfort care and dealing with other aspects of end-of-life care.” he said.
He also called for healthcare institutes to have adequate counsellors to help patients and their families to navigate through these difficult periods and help their decision-making process.
