Do not resuscitate : Indian Guidance

In India, the legal framework surrounding Do Not Resuscitate (DNR) orders and the withdrawal of life support has evolved significantly in recent years, particularly concerning terminally ill patients. The Supreme Court has played a pivotal role in recognizing the right to die with dignity, leading to the development of guidelines that influence eldercare practices.

Supreme Court Rulings and Legal Framework

In 2018, the Supreme Court of India acknowledged the right to die with dignity as a fundamental right under Article 21 of the Constitution. This landmark decision paved the way for legal recognition of Advance Medical Directives, commonly known as 'Living Wills,' allowing individuals to outline their preferences regarding life-sustaining treatments in case they become terminally ill and unable to communicate their wishes.

Further refining the process, in January 2023, the Supreme Court simplified the procedure for executing a Living Will. The revised guidelines stipulated that such directives could be made in the presence of a Notary or a Gazetted Officer, eliminating the previous requirement for countersignature by a Judicial Magistrate. This change aimed to make the process more accessible and less cumbersome for individuals expressing their end-of-life care preferences.

Draft Guidelines for Withdrawing Life Support

In September 2024, the Union Health Ministry released draft guidelines titled 'Guidelines for Withdrawal of Life Support in Terminally Ill Patients.' These guidelines provide a structured approach for healthcare providers when considering the withdrawal of life-sustaining treatments. The key conditions outlined include:

1. Declaration of Brainstem Death: The patient must be declared brainstem dead as per the Transplantation of Human Organs Act (THOA).

2. Medical Prognostication: A consensus among medical professionals that the patient's condition is terminal and unlikely to benefit from aggressive therapeutic interventions.

3. Informed Refusal: Documented informed refusal by the patient or their surrogate, made after understanding the medical prognosis, to continue life support.

4. Compliance with Legal Procedures: Adherence to procedures prescribed by the Supreme Court, ensuring that all legal and ethical standards are met.

These guidelines emphasize a patient-centric approach, ensuring that decisions regarding life support are made in the best interest of the patient, respecting their autonomy and dignity.

Implementation at the State Level

Following these national guidelines, states like Karnataka have taken proactive steps to implement the withdrawal of life support measures. In January 2025, the Karnataka government issued an order simplifying the process for withholding or withdrawing life-sustaining treatment in terminally ill patients. The order facilitates the establishment of Primary and Secondary Medical Boards within hospitals to assess and confirm cases where life support may be ethically and legally withdrawn. This initiative positions Karnataka alongside Kerala, which had already set up mechanisms for implementing Living Wills, thereby promoting a dignified end-of-life process.

Conclusion

The developments in Indian law regarding Do Not Resuscitate orders and the withdrawal of life support reflect a growing recognition of patient autonomy and the right to die with dignity. These legal frameworks and guidelines aim to ensure that decisions about end-of-life care are made ethically, respecting the wishes of terminally ill patients, and are supported by both medical and legal professionals. As these regulations continue to evolve, they significantly impact eldercare practices, emphasizing compassionate and personalized care for the aging population.

Disclaimer: This is a general outline and for information purpose only. For more details please contact your nearest health authority