Doctors to play major role in giving effect to 'living will'

Doctors across the country were today assigned a major role by the Supreme Court in giving effect to the "advance medical directive" or 'living will' of persons in persistent vegetative state and terminally-ill patients who refuse to get medical treatment.
A five-judge constitution bench, which recognised that a terminally-ill patient or a person in persistent vegetative state could execute a "advance medical directive" to refuse medical treatment, spelt out the safeguards to be followed during this process.
The bench headed by Chief Justice Dipak Misra said that when the doctor, treating a terminally-ill person undergoing prolonged medical treatment with no hope of recovery and cure of the ailment, would be informed about advanced directive, the medical practitioner shall ascertain its genuineness and authenticity from jurisdictional judicial magistrate before acting upon the same.

"The instructions in the document must be given due weight by the doctors. However, it should be given effect to only after being fully satisfied that the executor is terminally ill and is undergoing prolonged treatment or is surviving on life support and that the illness of the executor is incurable or there is no hope of him/her being cured," the court said.
The bench said if the doctor would be satisfied that instructions given in the document need to be acted upon, he shall inform the executor or his guardian or close relative about the nature of illness, availability of medical care and consequences of alternative forms of treatment.

It said that hospital, where such patient has been admitted, shall constitute a medical board consisting of the head of treating department and at least three experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology with experience in critical care and having experience of at least 20 years.

The members of the board would then visit the patient in the presence of his guardian or close relative and form an opinion whether to certify withdrawal or refusal of further medical treatment.
"This decision shall be regarded as a preliminary opinion," it said.
The bench said when the board would certify that advanced directive be carried out, the hospital shall forthwith inform about it to the jurisdictional collector who would then set up another medical board to look into it.

It said if medical board would concur with the initial decision of the medical board of the concerned hospital, they may endorse the certificate to carry out the instructions given in the advance directive.
"In the event the executor is incapable of taking decision or develops impaired decision making capacity, then the consent of the guardian nominated by the executor in the advance directive should be obtained regarding refusal or withdrawal of medical treatment to the executor to the extent of and consistent with the clear instructions given in the advance directive," it said.
The apex court said that chairman of the board nominated by the collector shall convey its decision to the judicial magistrate before giving effect to the decision to withdraw medical treatment to the patient.

The magistrate shall visit the patient at the earliest and after examining all the aspects, authorise implementation of the decision of the board, the court said.
It said if the medical board would refuse to grant nod, it would be open to the executor of the advance directive or his family members, the doctor or hospital staff to approach the high court and the Chief Justice shall set up a division bench to decide it expeditiously after affording opportunity to the state.
"The high court will be free to constitute an independent committee consisting of three doctors from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology with experience in critical care and with overall standing in the medical profession of at least 20 years," it said.

The court said that in cases where there is no advance directive about terminally-ill patients, the doctor treating him may inform the hospital which, in turn, shall constitute a medical board.