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Response of the centre for bioethics (tcb) to the draft bill on The medical treatment of terminally-ill patients (protection of patients and medical practitioners) bill

RESPONSE OF THE CENTRE FOR BIOETHICS (TCB) TO THE DRAFT BILL

 ON

THE MEDICAL TREATMENT OF TERMINALLY-ILL PATIENTS
(PROTECTION OF PATIENTS AND MEDICAL PRA
CTITIONERS) BILL

Introduction

This document records the response/comments/recommendations of TCB on the above mentioned bill. TCB as mentioned in the covering letter to this document, registered under the Societies Registration Act. 15 reputed organisations  have come together to form this organization.. The aim of this organization is to to improve Healthcare provision in India through Bioethics

This bill to provide protection of patients and medical practitioners in the context of withholding and withdrawing medical treatment is very welcome. We appreciate the fact that the Ministry of Health and Family Welfare, (MOHFW) Government of India  has made great efforts to guide the end of life practices in relation to treatment of the terminally ill in India.

TCB draws on its many years of experience in the field of Bioethics to make the following suggestions/comments/recommendations to the MOHFW with the hope that the same will be incorporated into the draft bill.

While making our recommendations we would like to highlight the following points as we feel that such a bill needs to pay special attention to these specific issues. The same are given below.

Highlights of our suggestions:

  • Protection of surrogate (spouse, adult son/daughter, etc.) decision makers to be included in the title of this\ bill
  • Definitions of Best interest of patient, Competent patient, Age of majority, Informed decision, Medical power of attorney, Palliative care, Terminally ill
  • Clinical ethics committees to be included
  • Do not resuscitate (DNR) to be legalized
  • Palliative care (active pain management)/comfort care should be promoted
  • Decision to decide about withdrawing/withholding should be with the Healthcare professionals and patient or his surrogate decision maker.
  • Age of Majority – 18 years
  • Documentation of informed decisions
  • Living will and durable power of attorney registered before a competent authority should be honored
  • Concern that we have to go to the courts

Specific Comments for inclusion:

  • Decision of patient / surrogate (Spouse/ adult son etc.) to continue futile / inappropriate treatment should not be binding on the doctor
  • Protection of medical professional acting on the informed decision taken by the surrogate (Spouse/adult son etc.)
  • Protection of the surrogate (Spouse / adult son etc.) decision maker of the terminally ill incompetent patient
  • Relevance of this bill in home based care to be articulated
  • Relevance of this bill in ward based vs ICU based care
  • Strengthen the existing healthcare system ensuring a continuum of care where cure is not possible
  • Promote palliative care /comfort care for the terminally ill competent and incompetent patients.
  • Euthanasia and Physician Assisted Suicide are illegal in India

In the document given herein below we have three columns. The first column has the original draft Bill with the title Draft Bill. Please note that the highlighted portion in this column indicates that a suggested change in the high lightened portion is given in the next column. The next column is titled Inputs which gives suggested changes in the sections and/or sub sections of the Draft Bill. The third column is titled Recommendations and suggestions. This section incorporates TCB’s vast experience in Bioethics and ethical issues and proposes the necessary suggestions that are to be kept in mind while drafting the bill.

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