In such cases their legal heir consents for the same and if not consented then hospital can't take any step to remove from ventilater. Hospital can only take decision to get the patient on to ventilater
Not giving consent for Ventilator Support for a terminally ill patient
Hi, If a patient’s close relative (son/daughter/husband/wife) does not give consent for ventilator support for a terminally ill patient, then would it be considered homicide/murder ? The situation might arise when the patient goes into coma and doctor confirms that the patient cannot recover. Putting on ventilator would just extend the suffering and instead the patient should be allow to die with the least pain possible. As per the law of Passive Euthanasia in India, its mentions that a patient must consent through a living will. But in such case there’s in no will present and a coma patient cannot sign a will then what should the family do.
Asked 4 years ago in Constitutional Law
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14 Answers
Thank you Prashant Nayak. I beg to differ. In this case, the hospital has asked for “Consent” from legal heir asking if he/she wants the patient to be put on the ventilator. If the heir says no to ventilator support then would it be considered murder ?
Asked 4 years ago
No it's not murder.
as an autonomous person, every individual has a constitutionally recognised right to refuse medical treatment. The right not to accept medical treatment is essential to liberty. Medical treatment cannot be thrust upon an individual… The reasons which may lead a person in a sound state of mind to refuse medical treatment are inscrutable. Those decisions are not subject to scrutiny and have to be respected by the law as an essential attribute of the right of the individual to have control over the body. The state cannot compel an unwilling individual to receive medical treatment”.
2) it would not be considered murder if close relatives refuse to place patient on ventilator
No but where doctor prescribed it very much necessary than they may prosecuted for culpable homicide.
But where doctor itself has declared no chances than such denial is not an offence.
Follow doctor directions. No possibility of recovery than to save money such denial is expected.
No murder.
A recent judgment by the Supreme Court of India has legalised the withdrawal of life support measures in patients in persistent vegetative state [2]. Such a decision to discontinue life supporting measures can be taken by parents, spouse or doctors attending patient in the 'best interest' of the patient.
Doctors will no longer always have to get permission from a judge to turn off a patient's life support. It comes after a legal ruling about a man in a vegetative state, who was unlikely to ever regain consciousness. .
Usually, they would need permission from a judge to take a patient off life support.
First, because the foregoing of life-sustaining therapy is only legally justified if such support represents unwanted treatment, it should be withheld or withdrawn only with the consent of patients or their surrogates, assuming surrogates are available.
Parents and doctors usually make decisions together about life support treatment.
In most situations medical teams will make sure that parents are in agreement before a decision is made to stop life support treatment.
A recent judgment by the Supreme Court of India has legalised the withdrawal of life support measures in patients in persistent vegetative state
Such a decision to discontinue life supporting measures can be taken by parents, spouse or doctors attending patient in the 'best interest' of the patient.
An informed consent is undoubtedly necessary when withdrawing life support in a brain dead patients.
However, legality and ethics of an informed consent in such cases is controversial. Parents/guardians need to be explained the grave prognosis of condition of their
brain dead child on life supporting measures.
The existing guidelines for withdrawal and withholding of treatment in brain dead children are complex.
Indian laws pertaining to treatment of terminally ill patients are dealt under section 14, 21 of Indian constitution and section 76, 81, 88, 306 and 309 of Indian Penal Code.
The law commission of India laid down an act for the medical treatment of terminally ill patients (protection of patients, medical practitioners).
According to this law, if a 'competent' patient who is afflicted by 'terminal illness' refuses treatment after being duly informed about all aspects of the disease and treatment, the doctor is bound to obey the same and withhold or withdraw treatment. However, when
the patient is 'incompetent' (includes minor, person of unsound mind) and is unable to take decisions for end of life, the doctor has to take a decision in the 'best interests' of the patient based upon an informed body of medical opinion of experts. The law might not apply in situations where the parents/guardians insist on continuation of life support measures despite being explained the inevitable outcome of the same.
The Do Not Resuscitate (DNR) order is still not documented legal practice in India.
It is a verbal communication between the clinician and the patient's relative or caregiver. The autonomy of the patient also remains a weak concept.
Even the right to live a dignified life or die a dignified death has not been extensively discussed.
The law is silent or ambiguous on most issues related to end-of-life care.
The financial status of the patient appears to be the deciding factor. In most cases health-care expenses are entirely borne either by the patient or by the patient’s relative
The DNR order is a well documented and accepted concept in most developed countries.
In India such guidelines are not followed in their entirety, or are difficult to follow when treating terminally ill patients.
Guidelines were recently proposed for limiting life-prolonging interventions and providing palliative care towards the end of life in Indian intensive care units
One of the first questions to be asked in such a case is: should the patient have been resuscitated at all?
This question addresses a major concern of medical ethics and law, about the patient’s right to choose the form and nature of his or her medical care, including the right to informed consent or informed refusal.
When the patient is not in a position to give consent, the consent given or obtained in such circumstances is called proxy consent. Ideally the patient’s relative or caregiver gives proxy consent. Proxy consent involves both substantive and procedural questions .
Ideally, a person with the most accurate and intimate knowledge of the patient’s recent wishes and lifestyle should give proxy consent.
S/he should have a maximum stake in the decision and should be responsible for the consequences.
- As pr the Section 3 of the Medical Treatment of Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill , a patient can tell the doctor that he does not want treatment and the same consent can be taken from the legal heirs /family of the patient .
- Further, A doctor must take the consent of the patient before commencing any particular treatment , but In a medical emergency, life-saving treatment can be given even in absence of consent.
- Since, there is life threatening treatment , hence under both the situations , the doctor will try to safe himself from the consequences, whether refusal or consent to put on the ventilator.
- Further, as per Supreme Court , the withdrawal of life support measures in patients in persistent vegetative state/decision to discontinue life supporting measures can be taken by parents, spouse or doctors attending patient in the 'best interest' of the patient.
- Hence, the consent for not to put on ventilator is not a murder.
1. There is no compulsion for a patient party to give ventilator support to the diseased man as the medical professionals often for commercial gain force to do so.
2. SO one can always refuse to give such support, more so, if he does not have that much of financial might.
3. on a personal note , in case of my father the Doctor himself asked us not give such support to him who was then terminally ill and allowed the nature to take its call.
1.Since ventilator support attracts expenses, the said close relative can take the stand that he is unable to bear the said expenses which compelled him to refuse consent for ventilator support.
2. In the above case, no charge of homicide/murder can be leveled against him/her.
No, it will not be considered as murder on the grounds mentioned in my earlier post.
Consent of the family members is required.
It does not amount to murder if consent is not given.
Hospital shall not by applying force give treatment if patient / patient's family members do not want.
Thus, it is your discretion to take a call, as non giving of consent for Ventilator does not amount to murder.
The Law Commission headed by the Supreme
Court Judge M. Jagannadha Rao, in its 400 pages report due to be tabled in Parliament, is a legal document that authorizes doctors in certain situations ‘to withhold’ or ‘withdraw’ ‘life support measures’ such as ventilators and artificial feeding. The Law Commission tried to clarify that “withdrawal of life support to patients is totally different from euthanasia and assisted suicide”.
Euthanasia, which is legal in only two countries,
Netherlands and Belgium, and one State in the
US, Oregon, is an act of any person, including a
doctor, to kill a terminally ill patient by giving drugs.
Assisted Suicide is an act of a patient who receives the assistance of a doctor and takes drugs with the intention of committing suicide.
On the other hand, denial of life support, which is legal in most countries, including India, applies to situations where the patient is in a critical condition or under coma and has been artificially kept alive through modern technology.
So it will not be considered murder or homicide if legal heirs of patient doesn't give consent for life support system.
If legal heir says no to ventilator it would not be considered murder