The Supreme Court of India sanctions living will and it may mean a huge burden on the physicians and the hospital. Here we present a quick summary of the judgment for the healthcare professionals.

The Supreme Court recently allowed passive euthanasia, paving way for those on life support and no hopes of recovery to die with dignity. The apex court put the onus on the doctor to determine if the patient is indeed incurable and should be allowed to breathe his last. This calls for the doctors to educate themselves about the nitty-gritty of the court's judgment.

According to the procedure fixed by the Supreme Court, a Living Will or Advance Directive is needed to discontinue life support of the patient. It is a written document, to be signed by the person concerned in front of a judicial magistrate of first class (JMFC) in the presence of two witnesses, who are there to ensure that the person signs the document voluntarily, without any external influence.A copy of the Will remains in the JMFC's office and one copy is forwarded to the competent officer of the local government body. Further, the JMFC has to inform immediate family members of the person concerned if they are not present at the time of signing the Will.

It is the doctor's responsibility to ascertain the authenticity of the Will when presented with one. The doctor/hospital will need to get it verified with the jurisdictional JMFC's office.

Whether or not the patient's condition is indeed incurable is also for the doctor to determine. The instructions in the Will must be given due consideration by the doctors. It should be given effect to only after being fully satisfied that the patient is terminally ill and is undergoing prolonged treatment or is surviving on life support and that the illness is incurable or there is no hope of him/her being cured.

If the physician is satisfied that the instructions given in the Will need to be acted upon, he shall inform the patient or his guardian/close relative about the nature of the illness, the availability of medical care and consequences of alternative forms of treatment and the consequences of remaining untreated. He must also ensure that he believes that the person in question understands the information provided and that withdrawing/refusing of medical treatment is the best choice.

The physician/hospital where the patient has been admitted shall then set up a Medical Board consisting of the head of the treating department and at least three experts from the fields of general medicine, cardiology, neurology, nephrology, psychiatry or oncology with experience in critical care and with overall standing in the medical profession of at least 20 years who, in turn, shall visit the patient in the presence of his guardian/close relative and form an opinion whether or not to allow passive euthanasia. This decision shall be regarded as a preliminary opinion.

The chairman of the Medical Board nominated by the Collector, that is, the Chief District Medical Officer, shall convey the decision of the Board to the jurisdictional JMFC. The JMFC shall visit the patient and, after examining all aspects, authorise the implementation of the decision of the Board.

If permission to withdraw medical treatment is refused by the Medical Board, it would be open to the executor of the Advance Directive or his family members or even the treating doctor or the hospital staff to approach the High Court by way of writ petition.

The article is contributed by a Bangalore based ground reporter, Elizabeth Mani, a member of 101Reporters, a pan-India network of grassroots reporters.