The Supreme Court redesigned the "cumbersome" process preventing the practice of passive euthanasia on Tuesday, establishing a clear schedule for medical experts and reducing the paperwork required for people who wish to withhold life-sustaining treatment when they are terminally sick.
A Constitution bench under the leadership of judge KM Joseph opened the door for significant revisions to the rules outlined in the high court's 2018 decision, making the stages in the procedure more time-bound and straightforward in respect of the right to a dignified death.
The court modified the prior ruling to eliminate the requirement that a judicial magistrate attest or countersign a living will and held that a notary or gazetted officer's attestation would be sufficient for a person to make a valid living will. The bench also included justices Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy, and CT Ravikumar.
The bench ruled that the living will would be a part of the national health digital record, which may be viewed by hospitals and physicians from any part of the country, rather than being kept in the custody of the relevant district court, as the court had instructed in 2018.
Another significant adjustment made by the bench concerned the composition of the main and secondary boards of physicians who would assess the patient's health and decide whether to follow the instructions provided in the advanced directive.
The primary board will be made up of three doctors, including the treating physician and two other doctors with five years of experience in the relevant specialty, according to the bench's ruling on Tuesday. The primary board was originally required to include at least four experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry, or oncology, with overall standing in the profession of at least 20 years.
The bench stated that the main board would ideally determine whether to discontinue further therapy within 48 hours. The 2018 ruling did not specify a maximum threshold for the main board's determination to carry out the living will.
If the primary medical board determines that the treatment should be discontinued in accordance with the instructions in the living will, the hospital must immediately establish a secondary medical board made up of two subject experts from outside the primary board who have at least five years of experience in the relevant specialty and a physician appointed by the chief medical officer of the district in question. The district collector in question was required to assemble the second board of medical experts in accordance with the 2018 verdict.
This board will likely make a decision within 48 hours. A 48-hour limit is appropriate in such scenarios, the bench said, adding that they may also need to consider the circumstances or contact others. The 2018 verdict did not provide a date for the secondary medical board.
The jurisdictional magistrate will be informed of the judgment as soon as both boards have given their approval for the execution of the living will, according to the bench.
The patient's family may file a complaint with the appropriate high court, which will appoint a new board of medical specialists to help it make a final decision if the hospital's medical board refuses to grant authorization to stop receiving medical care.
The family members of other terminally ill patients may also decide to withdraw treatment, subject to the safeguards and the procedure mentioned for those who did not prepare advanced directives. While those who are still living will designate the executors of their wills to consent on behalf of the terminally ill patients, the family members of other terminally ill patients may also choose to withdraw treatment.
The bench ruled that the new regulations should be communicated to all high courts, health secretaries in states and union territories, and chief medical officers in all districts in order to establish adequate standards for the keeping of digital copies of living wills.
The petitioner in the case that sought amendments to the 2018 ruling, Indian Society of Critical Care Medicine, and the Union government jointly proposed the changes, which the bench granted while also dictating a portion of the verdict in open court. The whole verdict will be made public later.
The Centre informed the bench last week that it will not adopt a law permitting passive euthanasia and said that the desire to end someone's life must not exceed the need for crucial protections. According to the administration, there is no need for a particular legislation on the topic since the highest court's 2018 decision to permit passive euthanasia after adhering to specified measures appropriately fills the space.
The Centre's statement came in response to a question from the bench on the status of a new law because the 2018 decision said that the court's rules would be in effect until legislation was filed on the subject.
The petitioners' argument that the three-step process involving onerous conditions has rendered the entire judgment nugatory and that there has not been a single instance where someone desiring to exercise the right to passive euthanasia could finally comply with the procedural requirements was being considered by the court, which was represented by senior counsel Arvind Datar and advocate Prashant Bhushan.
The court noted at last week's hearing of the lawsuit that the 2018 decision required "a little tinkering" to be practical.
An individual's right to a dignified death was recognized by a Constitution court in March 2018, which said that a terminally sick person might choose passive euthanasia and execute a living will to reject medical care. It allowed someone to create a living will that said they did not want to be placed on life support if they fell into an uncurable coma.
The current Chief Justice of India, Dhananjaya Y Chandrachud, was a member of the five-judge panel in 2018. He said in a separate ruling that: "Dignity in the act of dying is as much a component of the right to life under Article 21. An individual's sense of purpose in life is taken away when their dignity is violated at the end of their life.