Euthanasia

At present, no statistics are available on the subject. But, euthanasia is being practiced at present even in India! To deny this is like saying that abortions were never carried out before it was legalized. If we take a public opinion poll in India, we will arrive at a similar situation to one in California, where 70% of the electorate favored the legislative initiative for euthanasia.

So, instead of wasting time in useless and unfruitful philosophical discussions, the relevant statute laws framed elsewhere should be studied by a committee of experts and euthanasia should be legalized in India as early as possible.

Force Feeding

Force feeding a person who has voluntarily stopped taking any nutrition creates doubts among physicians. The dilemma is whether to respect the patient’s wishes and let the situation take its own course or to give parenteral nutrition to the patient against his wishes and save his life. The declaration of Geneva states that health of the patient should be the first consideration of the doctor. Thus, according to it, the doctor should proceed to force feed him against his wishes.

However, many feel that the doctor’s action should be guided by the Declaration of Tokyo adopted by the 29th World Medical Association in October 1975. Clause V reads: “Where a prisoner refuses nourishment and is considered by the doctor as capable of forming unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she should not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner”.

Care of Dying Patients in Hospital

Mills Mina et al in their paper describe a prospective study of 50 dying patients in the west of Scotland. The paper commences with the sentence: “Though most terminally ill patients indicate a preference to die at home…, more than 60% of all deaths occurred in an institution”. The conclusion is equally riveting. “Care of many dying patients observed in these hospitals was poor. We need to identify and implement practical steps to facilitate high quality care of the dying.”

Thus a thought should be given to this problem. This, of course, is a foreign study and the situation might differ in India. But when the prognosis of the patient is fully known and there is no provision of “Mercy killing”, the patient should be discharged instead of continuing to extract large sums of money from the already aggrieved family till the end and even after. One should adopt the policy of, “Always treat the family, not just the patient”.

Second Opinions & Referal

It is the right of the patient to seek a second opinion whenever he desires, and it is the duty of the doctor to refer the patient to another colleague whenever the situation so demands. But, it is a known fact that doctors for sake of monetary gain or for fear of lowering their reputation, do not consider timely referrals and the case ends in a disaster. The patients also do not know the right to getting a second opinion. If a patient asks his treating doctor regarding it, he should honor the patient’s wish rather than take it as an inability to keep the faith, so vital to the contract. The doctors themselves should understand their limitations and should not go beyond their skills. They should lay for themselves some guidelines with respect to referral of patients and issuance of second opinions. These are some of the ethical principles that doctors caring for the critically ill should bear in mind. This will not only prevent litigation but also improve the quality of patient care.