When the Supreme Court legalized the concept of ‘advance medical directives’ in 2018 and allowed passive euthanasia subject to stringent safeguards, it was seen as an important recognition of both patient autonomy and rights over end-of-life decisions Went. a dignified death. However, doctors later found that certain directions were “insurmountable obstacles”. In a recent order, a constitution bench amended the directions to make them more practical and simple. The advance directive is no longer required to be countersigned by the Judicial Magistrate. Instead, it can be attested before a notary or a gazetted officer. Instead of a magistrate, it is sufficient that the notary or officer is satisfied that the document has been executed voluntarily, without coercion or inducement, and with full understanding. In the event of the executor being incapacitated, the executor shall name a guardian or a close relative who shall be authorized to consent to the refusal or withdrawal of medical treatment, with the option of naming more than one guardian or has been modified for Relative. Instead of tasking the Magistrate to inform family members about the document, if they are not present at the time of its execution, the onus is now on the individuals themselves to serve a copy of the advance directive to the guardian or next of kin . This includes named relatives as well as the family doctor. It can also be incorporated into a digital health record.
As per the new guidelines, the hospital itself will have to set up a first aid board to certify whether instructions to refuse or withdraw treatment should be followed. The hospital should also form a secondary board, consisting of a doctor nominated by the chief medical officer of the district, who would have to endorse the certificate of the primary board. The change here is that the district collector is not required to constitute a second medical board, as required in the 2018 judgment. In cases where there is no advance directive, the investigation by the board is correct even in those cases, but the patient is not in a position to take a decision. The new guidelines also spell out the experience and expertise of those to be included in the medical board. While such guidelines are useful and necessary to implement the concept of ‘living will’ and carry forward medical directives, it is time Parliament came out with a comprehensive law. Such legislation may also provide for a repository of advance directives so that at the time of its implementation the need does not arise to ascertain its true nature afresh.