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With Kerala pioneering the landmark SC ruling’s implementation and Karnataka following suit, it is a matter of time before other states also implement it
Dignity in life is important, and so is dignity in death. Two South Indian states have taken giant strides to recognise this.
Last week, the Karnataka government issued a Government Order (GO) to implement the Supreme Court’s 2018 ruling allowing terminally ill patients to die with dignity. “Dying with dignity” here means withholding or withdrawing treatment that may be keeping the patient in a vegetative state with no possibility of recovery.
Karnataka put itself next to Kerala, which had already implemented this. Kerala, in fact, has gone a few steps further. In November 2024, the Government Medical College Hospital, Kollam, created a Living Will Information Counter on its premises to educate people on death awareness.
The counter has apparently piqued the interest not only of senior citizens but also the young. Per media reports, several members of the public, including 65 members of an extended family – aged between 18 years and 85 years – signed their Living Will.
Universal trauma
A Living Will can be signed by people aged 18 or more. It gives them a say in whether treatment should or should not be continued with if they are incapacitated or terminally ill, where there is no hope of recovery.
There is no doubt that this is a historic move — even if the Congress government in Karnataka may just be laying claim to some of the ‘progressivism’ that its neighbour has gained a reputation for.
Most of us, sometime or the other, have gone through the trauma that caregivers experience when a dear one is terminally ill or incapacitated. Even when there is no hope of recovery and one wants the patient not to suffer further, inertia due to emotional, ethical or cultural reasons exacerbates the suffering of both patient and caregiver.
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Fundamental right
In 2005, Common Cause, a registered society, through noted advocate and activist Prashant Bhushan, approached the Supreme Court, praying that the right to die with dignity should be a fundamental right under Article 21 (right to life and personal liberty). It also prayed that the court issue directions to the Union government to allow terminally ill patients to execute ‘Living Wills’ for appropriate action in the event that they are admitted to hospitals.
A five-judge Bench, on March 9, 2018, held that the right to die with dignity is a fundamental right. According to the Supreme Court Observer, the Bench ruled that an individual’s right to execute advance medical directives is an assertion of the right to bodily integrity and self-determination and does not depend on any recognition or legislation by the State.
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Further, the Indian Society for Critical Care filed an application on July 19, 2019, requesting a five-judge Constitutional Bench to modify some of the guidelines specified in the 2018 verdict. The claim was that patients could not exercise their right to die with dignity as the process involved was complicated and therefore required streamlining.
On January 23, 2023, the apex court simplified its 2018 guidelines on certification for withdrawing/withholding of treatment. The new guideline required only a gazetted officer or notary and two witnesses to ensure that the Living Will has been executed voluntarily, without coercion and with understanding. Whereas, earlier, it required countersigning by a Judicial Magistrate.
Time to follow suit
With Kerala pioneering this landmark ruling’s implementation and Karnataka following suit, it is a matter of time before other states also initiate it.
Kerala, however, has gone on to set up a Primary Medical Board, a prerequisite for implementing Living Wills. How quickly Karnataka sets up its Primary Medical Board and takes proactive steps to see its success remains to be seen.
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While on the subject of dignity, one cannot but reflect on the indignities piled on patients – both living and dead – and their caregivers in our healthcare system. While the rich can buy dignity of a sort in private hospitals that offer packages akin to 4-days-3-nights stay in tourist resorts, dignity dies a thousand deaths in government hospitals, where there is no privacy, courtesy or cleanliness.
About how the dead are handled, the less said the better. The trauma continues for caregivers even after the patient’s suffering ends.
It is only when the right to die with dignity is understood through the right to live with dignity, and as human dignity, can the trauma for patients and caregivers end. That should be the logical end to this initiative.
(The Federal seeks to present views and opinions from all sides of the spectrum. The information, ideas or opinions in the article are of the author and do not necessarily reflect the views of The Federal.)