Following the Supreme Court’s landmark decision on January 24, 2023, which permits the withdrawal of life support for patients with no hope of recovery or those in a persistent vegetative state, the Karnataka government has officially implemented guidelines to uphold the "right to die with dignity." This makes Karnataka the second state in India, after Kerala, to adopt such measures.
The state’s health department has established a Secondary Medical Board comprising medical experts to determine when life-sustaining treatment can be discontinued for terminally ill patients. This decision applies to individuals undergoing prolonged treatment with no prospects of improvement or those in a vegetative state where further medical intervention may cause more harm than benefit.
Additionally, the government has introduced the concept of an Advanced Medical Directive (AMD), commonly known as a living will. This legal document allows patients to outline their preferences for future medical treatment. Under the new guidelines, specialists such as neurologists, neurosurgeons, surgeons, anaesthetists, and intensivists, who are already authorized to certify brain-stem death under the Transplantation of Human Organs and Tissues Act, 1994, are eligible to serve on the Secondary Medical Board. District Health Officers (DHOs) across Karnataka will automatically recognize these professionals for this role.
Procedure for Withholding Treatment
The guidelines outline a detailed process for discontinuing life support. First, the treating physician must approve the decision. Subsequently, the hospital must form two medical boards—a Primary Medical Board and a Secondary Medical Board—each consisting of three registered medical practitioners. The Secondary Medical Board must include a doctor nominated by the DHO. Both boards will evaluate the patient’s condition and consult with the family or the individual designated in the AMD before making a decision.
The final decision must be submitted to the Judicial Magistrate of the First Class (JMFC) for review. The JMFC will then forward the decision to the High Court Registrar for official documentation.
Understanding Advanced Medical Directives (Living Wills)
An AMD is a legal document that allows mentally competent adults to specify their preferences for future medical treatment. Patients can appoint two trusted individuals to make decisions on their behalf if they become incapacitated. Once created, the AMD should be shared with a government-appointed officer and included in the patient’s medical records, whether digital or physical. This ensures that healthcare providers are aware of the patient’s wishes and can respect them when necessary.
Transplantation of Human Organs and Tissues Act, 1994,
The Transplantation of Human Organs and Tissues Act, 1994, is a significant piece of legislation in India that regulates the removal, storage, and transplantation of human organs and tissues for therapeutic purposes. The primary aim of the Act is to prevent commercial dealings in organs and to promote ethical practices in organ donation and transplantation. Here are some key features of the Act:
Definition of Terms: The Act clearly defines terms such as "donor," "recipient," "near relative," and "transplantation," ensuring clarity in its application.
Authorization Committees: The Act mandates the formation of Authorization Committees at the state and central levels to oversee and approve organ transplants, particularly in cases where the donor is not a near relative of the recipient.
Regulation of Living Donors: The Act allows organ donation by living donors, but only near relatives (spouse, parents, siblings, children, grandparents, and grandchildren) are permitted to donate without prior approval from the Authorization Committee. Non-relative donations require scrutiny and approval to prevent organ trafficking.
Cadaver Donations: The Act promotes cadaveric (deceased) donations by establishing procedures for the removal of organs from brain-dead individuals. It also recognizes brain death as a legal form of death, which is crucial for organ retrieval.
Prohibition of Commercialization: The Act strictly prohibits the buying and selling of organs and tissues, making it illegal to trade human organs for financial gain. Violations can lead to severe penalties, including imprisonment and fines.
Registration of Hospitals: Hospitals and medical institutions involved in organ transplantation must be registered under the Act. They are required to meet specific standards and follow ethical guidelines.
Punishment for Offenses: The Act prescribes stringent penalties for violations, such as illegal organ trade or unauthorized transplants. Offenders can face imprisonment and hefty fines.
Amendments: Over the years, the Act has been amended to address emerging challenges and improve its effectiveness. For instance, the Transplantation of Human Organs and Tissues (Amendment) Act, 2011, expanded the scope to include tissues alongside organs and introduced stricter regulations to curb illegal practices.
The Act plays a crucial role in ensuring that organ transplantation in India is conducted ethically, transparently, and with the utmost respect for human dignity. It has helped save countless lives by facilitating legal and ethical organ donations while combating exploitation and commercialization in the field.
The Health Department highlighted that AMDs help medical professionals align treatment with the patient’s desires, ensuring their autonomy is respected during critical moments. This progressive step by Karnataka reflects a growing recognition of patient rights and the importance of dignity in end-of-life care.
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