[8 May 2024] The Hindu Op-ed: A dignified peaceful passing is everyone’s right

Mains PYQ Relevance: 

Q) Appropriate local community-level healthcare intervention is a prerequisite to achieving ‘Health for All’ in India. Explain. (UPSC IAS/2018)
Q) To enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC IAS/2020)


Prelims: Right to life; Right to health; Right to die with dignity;

Mains: Judicial Intervention in Health Care sector;

Mentor comments: Death is inevitable, the one certainty in life. When the time comes, and if you have an incurable disease, how would you like to go? Would you prefer your bed in your home, with your loved ones around you? Or would you prefer being all alone in an Intensive Care Unit (ICU) with a tube in every orifice, hooked to machines that measure the functioning of every vital organ in your body, with each malfunctioning organ supported artificially? When facing an incurable illness, the choice between passing away at home surrounded by loved ones or in an ICU on life support is deeply personal (Right to Privacy). Some prefer the comfort and intimacy of home, while others seek every medical intervention, even if alone. There have been long debates on euthanasia and Palliative care for old people to protect their rights. Courts, through various decisions, have recognized the right to die with dignity as a fundamental right and an integral part of the right to life under Article 21.

Let’s learn

Why in the News?

Ronald Reagan, the 40th President of the USA, died at 93 in his home surrounded by his family members (2004). However, India’s former PM Atal Bihari Vajpayee died (2018), nine years after a stroke that had left him non-ambulant. 

  • Hence, communicating end-of-life wishes is crucial to ensure one’s final moments align with their values.

What is the difference between Life support System and Palliative Care?

Life support SystemPalliative Care System
What is it?It aims to prolong life by artificially maintaining vital bodily functions.It focuses on improving quality of life by relieving symptoms, pain, and distress, regardless of prognosis.
Treatment It involves invasive medical interventions like ventilators, dialysis, and feeding tubes.It emphasizes comfort-oriented, non-curative treatments to alleviate suffering.
GoalsTo sustain life, even if it means prolonging the dying process.To enhance quality of life and provide comfort, even if it means foregoing life-prolonging treatments.
TimingUsed in critical, end-stage illness when curative treatment is no longer possible.Can be provided at any stage of a serious illness, even alongside curative treatments.

End-of-Life Practices: West vs. India

  • West Scenario: Advance directives for common, terminally ill allowed Natural Death by withdrawing life support.
  • Europe Scenario: Only 10.3% die on life support, others shifted to Palliative Care.
  • Indian Scenario:
    • 70% of incurable patients die on life support in ICUs, alone.
    • The remaining 30% die through “Left Against Medical Advice” – ethically questionable. A survey in Pune showed 83% prefer to die at home.
What is the LAMA/DAMA Practice?

Left Against Medical Advice/Discharged Against Medical Advice (LAMA/DAMA) refers to a patient leaving the hospital against the advice and recommendation of their treating healthcare providers.

Its Causes:  Financial constraints, Belief in alternative therapies, Dissatisfaction with care, Terminal/advanced illness, and Lack of understanding about the treatment process. It adversely affects patient outcomes, increasing the risk of mortality and the need for readmission.

The practice is considered ethically questionable, as it represents unplanned treatment limitations without a formal shift to palliative care.

Challenges in Indian Context:

  • ICU Routinisation: 
    • Society has a mistaken belief in prolonging life at all costs and accepts ICU death as normal 
    • In recent years, a lack of adherence to ethical principles and routinization of intensive care deaths has become more common.
  • Lack of Legal Clarity:
    • Lack of death literacy and inability to make informed decisions plays a major setback in Indian Society.
    • Further, the absence of a Legal Framework for End-of-life Care in India creates wider challenges for hospital staff and patients.
    • The term “Passive Euthanasia” is considered a misnomer by ICMR. Withholding or withdrawing life support in futility is not euthanasia but allowing natural death.

Initiatives taken on Palliative Care and Living Wills:

  • By WHO:
    • WHO defines health as “physical, social, and mental well-being” beyond just the absence of disease.
    • World Health Day (April 7) has passed and the theme for 2024 was “My health, my right”. 
  • By India (through Judicial intervention):
    • SC in 2018 recognized passive euthanasia and the ‘Right to die with dignity’ as a fundamental right subject to guidelines.
      • India’s Supreme Court (three-member Bench) ruled that the ‘Right to Health includes the ‘Right to palliative care’.
    • SC verdict of 2023 recognizes advance medical directives and withdrawal of life support in futility cases.

Conclusion: The Lancet Commission Report 2022 speaks on the Value of Death and that modern society has become death-illiterate. Therefore, it is much required to bring awareness in our Indian Society on the value system of “dignified death”.

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