Medical Treatment of Terminally Ill

Patients Bill: Voice of Indian Doctors

Report submitted to:

Ministry of Health and Family

Welfare, Government of India
By

PlexusMD
Dated: 18 June, 2016
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 1

Contents

1. Executive Summary ................................................................................................................... 1

2. Background: The Proposed Bill ................................................................................................... 2
3. Background: PlexusMD .............................................................................................................. 4
4. Objective of the Survey .............................................................................................................. 5
5. Materials and Methods .............................................................................................................. 6
6. Results ....................................................................................................................................... 7
i. Profile of Respondents ........................................................................................................... 7
ii. Support For the Bill .............................................................................................................. 10
iii. Key Recommendations from the survey respondents (doctors) on the draft bill : ................. 13
iv. Select quotes from Doctors on the Passive Euthanasia Bill: .................................................. 20
v. Recommendations Word Cloud............................................................................................ 25
7. Conclusion ............................................................................................................................... 26

Appendix A - The Proposed Bill ........................................................................................................ 27

Appendix B - Government Circular................................................................................................... 28
Appendix C - PlexusMD Editorial ...................................................................................................... 29
Appendix D - Survey Form ............................................................................................................... 30
Appendix E - Responses ................................................................................................................... 31
Appendix F - About PlexusMD......................................................................................................... 32
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 1

1. Executive Summary

In May 2016, the Ministry of Health and Family Welfare uploaded a draft of the Passive
Euthanasia Bill on its website and is inviting public opinion/comments till 19th June 2016.
The Bill titled the Medical Treatment of Terminally Ill Patients (protection of patients and
medical practitioners), has been proposed by the Law Commission in its 241st Report. It
gives terminally ill patients the right to "withhold or withdraw medical treatment to herself
or himself" and "allow nature to take its own course".

PlexusMD (www.plexusmd.com), is an online community of doctors and medical students in

India. Over 50,000 doctors and students use PlexusMD to stay updated on the latest news
and developments in Medicine. On 16th May, 2016 PlexusMD ran an editorial on the
proposed Euthanasia Bill on its website and app and circulated a survey amongst its
members inviting them to show their support for/objection to the bill and share their
views/comments on the same. The objective was to gauge the overall opinion of the
medical community on the sensitive topic of legalising Passive Euthanasia and present the
key recommendations to the Ministry in order to help them draft a stronger and more
comprehensive bill.

A total of 956 doctors across 57 specialties and 211 cities India participated in the survey. A
significant majority (91%) of the doctors have shown support for the bill. The trend was
similar across various segments like age-groups, city and specialty. Over 320 doctors have
given their recommendations on key aspects of the bill - definition of the terminally ill,
emphasis on informed consent, and the constitution of the committee formed to approve
the request for Passive Euthanasia. The overall analysis reveals that doctors are hopeful that
such legislation would considerably help reduce the moral and legal dilemmas faced by
them in dealing with patients suffering from incurable conditions.

We hope that this exercise proves useful in gauging and conveying the prevailing opinion of
the medical community on the subject of legalising passive euthanasia and we hope the key
insights shared by the doctors shall help the policy makers in strengthening the Bill.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 2

2. Background: The Proposed Bill

The provision for Euthanasia was first discussed in the Ministry based on the 196th report of
the Law Commission of India on `The Medical Treatment of Terminally ill Patients
(Protection of Patients and Medical Practitioners) Bill 2006. The health ministry had opted
not to make any law on euthanasia back then.

In March 2011, the Hon'ble Supreme Court in its judgement on Aruna Shanbaug vs. Union of
India case, laid down guidelines to process "Passive Euthanasia" in case of incompetent
persons and said the guidelines should be followed all over India until Parliament passes
legislation on the matter.

In August 2012, the Law Commission in its 241st Report called 'Passive Euthanasia - A
Relook' again proposed making a legislation on passive euthanasia and prepared a draft bill
called the Medical Treatment of Terminally Ill Patients (protection of patients and medical
practitioners) Bill (Appendix A). This bill gives terminally ill patients the right to "withhold or
withdraw medical treatment to herself or himself" and "allow nature to take its own
course".

In May 2016, the MOHFW contemplated to enact/not enact a law on Passive Euthanasia,
based on the Report of the Law Commission. The Ministry is inviting comments from the
public, including Doctors till 19th June, 2016 (Appendix B).

The Key points to note in the Proposed Bill

1. Every competent patient including a minor above the age of 16 years has the right to
take a decision and express the desire to the medical practitioner attending him/her
a. for withholding or withdrawing medical treatment to herself/himself and
allow nature
b. to take its own course
c. for starting or continuing medical treatment to herself/himself
2. In case of a minor above 18 years of age, the consent should also be given the major
spouse and parents
3. Such a decision is binding on the medical practitioner provided the doctor feels the
terminally ill patient is making an informed choice, and after the patient has
communicated the same to his/her spouse and parents
4. The DGHS, Central Government and Director of Medical Services in each state shall
prepare a panel of medical experts for the purpose of this Act
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 3

5. The medical practitioner shall maintain a record of the personal details, nature of
illness, the decision of the patient and his opinion whether it would be in the best
interest of the patient to withdraw or withhold the treatment
6. The said medical practitioner as well as patient would be protected from any
criminal or civil liability
7. In case of an incompetent patient or a competent patient who has not taken an
informed decision, the case has to be filed in that area's High Court by the patient's
relative, friend or the medical practitioner. In such cases, the High Court is expected
to pass a judgment within a month.
8. The Advance Medical Directive as to medical treatment shall be void and shall not be
binding on any medical practitioner
9. The Medical Council of India may prepare and issue guidelines from time to time to
guide the medical practitioners in the matter of withholding or withdrawing medical
treatment to competent or incompetent patients suffering from terminal illnesses.
10. The Bill explicitly excludes active euthanasia from its purview
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 4

3. Background: PlexusMD

PlexusMD (www.plexusmd.com) is India's leading online community of doctors. Over 50,000

doctors and medical students across India use PlexusMD to discover the latest news and
developments in Medicine, collaborate with peers and stay updated.

Today, PlexusMD has become the single-stop platform for breaking news and key updates in
Medicine tracking developments across 50 specialties and from 300+ sources daily. Many
leading institutions, which include journals like BMJ India, hospitals like AIIMS, Columbia
Asia, Narayana Health, Manipal Hospitals and organisations like Karnataka red Cross Society
use PlexusMD to share their key updates.

Our editorial team ensures that we are the first to break any new policy, policy update,
revision of practice guidelines and any disease/drug alerts to our doctors. A few notable
stories shared on our platform in the last 12 months include Revised Bio-Medical waste
Management Rules - 2016, MCI's Advertising Guidelines in Medical Practice and Revisions of
PCPNDT Act.

We first shared the update on the Draft Passive Euthanasia Bill on 16th May, 2016. To drive
awareness regarding the Bill among the doctor community in India, we published an
Editorial (Appendix C) on the subject and invited views and recommendations from
PlexusMD members and other doctors across India. We received an overwhelming response
and the results are shared on the subsequent pages. We hope the Voice of Indian Doctors
helps the Ministry in strengthening the Bill and in subsequent stages.

PlexusMD, (Plexus Professionals Network Private Limited, Ahmedabad) was founded in

August 2014 by Dr. Rohan Desai (MBBS, MBA - IIM Ahmedabad), Dr. Binal Doshi (MBBS,
MBA - IIM Kozhikode) and Kinnar Shah (B. Tech Comp. Sci., MBA - SPJIMR Mumbai).
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 5

4. Objective of the Survey

Euthanasia is an extremely sensitive issue and doctors are faced with the dilemma of
whether to prolong/not prolong the suffering of a terminally ill patient every day. They are
one of the key stakeholders and their opinion is vital in shaping the policy. We started the
initiative by first educating the doctors on the history and timeline of euthanasia in India
and informing them about the key highlights of the Proposed Bill on Passive Euthanasia.

The Survey was rolled out with a two-fold objective:

a. To understand the overall support/opposition to the bill among doctors, and

b. To receive doctors’ suggestions, comments and recommendations on the bill which could
be of help to the law-makers in strengthening the bill
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 6

5. Materials and Methods

The survey was designed as a Google form (Appendix D). The following data was captured
for each respondent -

a) Support for/ Objection to the Bill

b) Suggestions/ Comments on the Bill

c) Respondents' Name, Email id, Specialty, City, Age

The following channels were used to administer the survey -

1) Email to PlexusMD members and doctors across 250+ cities and 80+ specialties in India

2) Notification via PlexusMD App to PlexusMD members

3) Via Whatsapp messages

Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 7

6. Results

A total of 956 responses were received. Subsequent sub-sections reveal the profile of the
respondents, the results of the survey and key recommendations by the doctors both 'For' and
'Against' the Bill.

i. Profile of Respondents

Profile of Respondents: City

(n=784)
340

65 84 76
37 24 38 34 25
14 10 12 15 10

Figure - a | Profile of Respondents - City-wise

City of residence was available for 784 of 956 respondents. Respondents from 211 cities across India
participated in the survey. 48% responses belong to Metros and Tier-1 cities including Mumbai, New
Delhi, Bengaluru, Hyderabad, Ahmedabad, Kolkata, Chennai and Pune.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 8

Profile of Respondents: Specialty

(n=498)
132
112

41 47
32 31 35
20 20 11 17

Figure - b | Profile of Respondents - Specialty-wise

Information about the doctor’s specialty was available for 498 respondents. Doctors across 57
specialties participated in the survey. Maximum responses (27%) have come from Physicians
(General Medicine and Internal Medicine), followed by Anaesthesia and Critical Care Medicine
(13%), Paediatricians (9%), Obstetricians and Gynaecologists (8%) and Ophthalmologists (7%).
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 9

Profile of Respondents: Age-group

(n=361)

86
78 75
61 61

18-25 26-30 31-40 41-55 >55

Figure - c | Profile of Respondents - Age-wise

The respondents were almost equally distributed across age-groups, with the average age of
respondent being 40 years and the median age being 35 years. One-third of the respondents were
under the age of 30 years and around 20% were over the age of 55 years.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 10

ii. Support For the Bill

Support for the Passive Euthanasia Bill

(n=956)
Against For

88, 9%

868, 91%

Figure - d | Support For the Passive Euthanasia - Overall

As seen in the above chart, a significant majority of the doctors are in favour of the Passive
Euthanasia Bill. 91% of the respondents (868/ 956) are in favour of the bill while only 9%
respondents are against it.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 11

Support for the Bill: Top cities

Against For

11
35 59 34 9 31 76 69 23
24 12 15 10

3
2 6 4 1 3 8 7 2

Figure - d | Support For the Passive Euthanasia - Top Cities

The above chart shows the top 10 cities from which responses were received. Across cities, there is
a similar trend with 85-90% doctors being in support of the bill.

Support for the Bill: Top Specialties

Against For

99 15 28 15
30 28 18 39 10 44

13 5 7 2
2 3 2 2 1 3

Figure - f| Support For the Passive Euthanasia - Top Specialties

The above chart shows the top 10 specialties from which responses were received. Doctors across
specialties were in strong favour of passing the Passive Euthanasia Bill.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 12

Support for the Bill: By Age-group

Against For

54 56 76 70 64

7 5 10 8 11

18-25 26-30 31-40 41-55 >55

Figure - e | Support For the Passive Euthanasia - Top Cities

Doctors across age-groups are in support of the Bill, with the same split of For/Against across all
segments.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 13

iii. Key Recommendations from the survey respondents (doctors) on the

draft bill :

A. On the procedure, protocol and constitution of the approval committee, On the role of
Doctors

1. A panel of Doctors from at least three different specialities (preferably including the
speciality involved in the illness of the patient) assessing independently and
concluding that termination of life is a better option for the patient and helplessness
of the family. ---Dr. Mahadev Desai , Ahmedabad (mahadevdesai@yahoo.com)

2. Its cruel to make a terminally ill patient suffer pain against his or her will but it
should be foolproof. Only a very high authority should be able to decide whether to
grant this or not. ---Dr. Prachi Gupta, Mohali (prachiniit@yahoo.com)

3. Domain specialization for panel is must and at least one member should be from the
discipline which is responsible for the primary care of the patient. ---Dr. Santam
Chakraborty, Mumbai (drsantam@gmail.com)

4. To prevent misuse opinion of a CMO and a magistrate must be made mandatory ---
Dr. Neena Singh, Kanpur (dr_neenasingh@yahoo.co.in)

5. A certified medical board shall decide the withdrawal of life support system in a
terminally ill patient when the chances of recovery is virtually nil in agreement with
family. ---Dr. Arun Shah, Muzaffarpur (drarunshah@hotmail.com)

6. At least 2 doctors of that particular field of medicine which patient is suffering from
should give same opinion for that particular patient --- Kandra Prasanth , Kakinada
(prasanthkandra@gmail.com)

7. Whenever, if ever, the government plans euthanasia pls ensure that one signatory to
the decision is a PALLIATIVE CARE SPECIALIST involved in the care of this patient for
no less than 3 months (Preferably 6 months.) --- Nishant Sahay, Patna
(nishantsahay@gmail.com)

8. Any long standing illnesses requiring artificial ventilation for more than 6 months,
with deep coma, where no hope for cure is seen, after proper counselling of
relatives, in presence of atleast 3 medical consultants similar opinion, (one among
them must be from hospital other than in which said patient is admitted), in
presence of two advocates (one from hospital & other from patient's relatives),
after 48 hours of documented intimation to local police station & district judiciary,
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 14

discision can be taken to withdraw life support. ---Dr. Minol Amin , Ahmedabad
(drminol@gmail.com)

9. Decision must be taken by a competent board of doctors instead of individual

treating doctor keeping in mind this highly sensitive step. ---Dr. R Dudeja, New Delhi
(rkdudeja2001@yahoo.co.in)

10. It has to be approved not just by the treating doctor, but also by a social worker after
certifying the patient's complete background, ruling out other financial conditions
making him take such a decision & also a psychotherapist. ---Dr. Sameer Kanakiya,
Mumbai (dr.sameer18@gmail.com)

11. Formation of a new vigilance council comprising of judges & retired doctors to
monitor & update the euthanasia protocols over the years. ---Dr. Sameer Kanakiya,
Mumbai (dr.sameer18@gmail.com)

12. The doctor administering euthanasia should have minimum 10 years of standing in
profession. Require a second opinion in writing from another doctor with same
standing before carrying out the procedure. ---Prof C M K Reddy President TN
Medical Practitioners' Association & Former President, Tamil Nadu Medical Council,
Chennai (profcmkr@yahoo.co.in)

13. There should be a standard format of consent form for euthanasia. If doctors write it
separately, a few words here and there can change the meaning entirely. A uniform
proforma should be followed all over the country. Details of the sequence of the
procedure should be described (medications, monitoring, etc) and should be
understood easily by patient (if general and neurological condition permits) and/or
next to Kin (attending family members). ---Abhijit Nair , Hyderabad
(abhijitnair95@gmail.com)

14. "The request for withdrawing support must be made in front of next of kin, and two
doctors and a video record of the same must be saved.

15. The decision of withdrawing support must be made by concensus of three doctors
one of which should be the medical suprintendent of the hospital and recorded on a
legally formatted proforma, witnessed by next of kin and two independent unrelated
individuals. ---Maj Gen (Dr) Atul K Sharma AVSM (Retd), Chandigarh
(drakmsharma@gmail.com)"

16. The patients wish should be authenticated by two independent authorities to

prevent misuse for suicide attempts. Some provision for patients on life support who
may not be in a position to give consent and who may never regain consciousness.
Two close relatives with one social worker or government authority should be able
to give consent. ---Dr. Pavan Kumar, Hyderabad (pavan.sge@gmail.com)
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 15

17. In case of incompetent patients , the procedure needs to be simplified, by

constituting panel of experts at Medical College level with the Superintendent as
Chairman, so that the relatives or friends can approach them easily. The procedure
in the bill is cumbersome and not practical. Only in case of difference of opinion, can
the courts of law be involved. ---Murali Mohan V., Hyderabad
(slnsp2003@yahoo.co.in)

18. In principle the idea is good. But the matter should not be between the attending
doctor and patient. A committee (on the lines of committees deciding on Renal
transplant donors) should be identified and given legal status to oversee these
requests and give the go ahead to withdraw or withhold life support. These
committees must be available at each district head quarters to save time and avoid
procedural delays. The members of the committee should include a respectable
senior citizen, a representative from the judiciary and a bureaucrat, in addition to a
senior medical practitioner. This way it will absolve the attending physician of any
legal complication later. ---Dr Lakshminarayana, Kakinada (doctorsvl@yahoo.com)

B. On the category of patients who may be administered Passive Euthanasia

1. Also, euthanasia in other illnesses or conditions wherein even if life is salvaged, living
would be beyond reasonable tolerance should be included in this bill or a new bill
can be proposed

2. Category of patient which can be included:

a. Terminally ill patients suffering from incurable diseases or chronic diseases,

with patient's consent and voluntary desire

b. Quadriplegic patients due to spinal injury or pathology who show no signs of

improvement even after a period of one year, with patient's consent and
voluntary desire

c. Brain dead patients certified by two qualified doctors with consent of two
close relatives ---Dr. Hrushikesh Mehata, Pune
(spinedochrushikesh@gmail.com)

3. Should include terminal illnesses like Cancer, or progressive debilitating diseases like
Alzheimer's , Parkinson's, CVA where the patient can decide this before he reaches a
point of not being able to take a decision. ---Dr. Ajit Man Singh, New Delhi
(ajitmansingh@hotmail.com)
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 16

4. I feel the definition of terminally ill needs to be redrafted, taking the opinion of
experts, as it appears to be too wide and is capable of misinterpretation . ---Murali
Mohan V., Hyderabad (slnsp2003@yahoo.co.in)

5. Not just terminally ill patients but people suffering from certain disease like
degenerative neurological diseases which are not fatal but severely affects quality of
life should also be considered. ---Parth Shah, Surat (tresconium@gmail.com)

C. On the age limit for eligibility for Passive Euthanasia

1. Passive euthanasia should be legalized for all ages. ---Dr. Vishrut K S, Chandigarh
(vks.social@gmail.com)

2. The age I believe can be made to at least an adult i.e. 18 yrs & above. ---Dr. Sameer
Kanakiya, Mumbai (dr.sameer18@gmail.com)

3. In first stage it should applicable to people above 70. It should be reviewed after one
year. ---Balwantraj, Mumbai (balwant55@yahoo.com)

4. This right should not be given to 16yrs old. He is not mature enough to take such a
big decision.Minimum age should be 21yrs ---Dr. Kailash Bhatia, Gurgaon
(kailashbhatia@hotmail.com)

5. I think the age limit for making an informed choice should be at least 21 years and
not 16 years as proposed. ---Dr. Sushil Fotedar, New Delhi
(sushilfotedar@gmail.com)

D. On patient’s informed consent and medical fitness to give consent

1. Patients should be given more autonomy. The current draft bill is loosely worded
with respect to involvement of the doctor and transfers more than needed power in
doctor's hands. ---Dr. Vishrut K S, Chandigarh (vks.social@gmail.com)

2. This should require that the patient be certified to be fit to take decisions regarding
his death. ---Dr. Ayan Chatterjee, Kolkata (drayandental@gmail.com)

3. The authority to declare a patient fit for euthanasia shouldn't be the treating team's.
---atma ram bansal, Gurgaon (atmarambansal@gmail.com)
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 17

4. It should be only and only with patients' written informed consent. If patient is not in
condition to give consent then at least 3 first degree relatives. ---Atul Singh,
Gorakhpur (draksingh78@gmail.com)

5. Patient who is suffering from terminally ill condition himself/herself should willingly
express this desire & consent for the same in presence of two doctors (one should be
necessarily be a treating doctor) & two other witnesses one of which should be
necessarily a close relative. Patient should also be in a mentally sound state & under
no external pressure & under no drug or medicine influence while expressing his/her
consent. Patient should be above 18 yrs of age. He/She also should be able to roll
back her decision whenever he/she desires till his/her death understanding the lost
treatment period & its consequences. ---Dr. Hrushikesh Mehata, Pune
(spinedochrushikesh@gmail.com)

6. Patient's desire should be recorded in front of the Doctor, a relative and a third
person who has no connection or interest in the patient in the past or present. ---
Pramila Jacob FRCP, Thiruvalla (pramilajacob@gmail.com)

7. When a said medical condition is terminal the choice should definitely be the
patients' as life support measures can only prolong and never cure. Close relations
should be only informed but not involved in the decision making which should solely
be patients. ---Malarvizhi, Chennai (mallarvizhiramesh@gmail.com)

8. I feel that to prevent injustice, the opinion of the patient needs to be taken atleast
twice in a gap of 6-7 days. This may prevent, to certain extent, misuse of the Bill and
also the time frame may allow the patient to think over and change his decision if he
feels so. ---Dr Lipi Chakrabarty, Bhilai (dr.lipi@gmail.com)

E. On Living will (Advance Medical Directive)

1. Advance directives and medical power of attorney to be void is not correct. It will
lead to unnecessary legal hassles for an already troubled family. ---Santam
Chakraborty, Mumbai (drsantam@gmail.com)

2. A Living will should get a proper legal status. ---Sharad Shinde, Mumbai
(sdshinde@gmail.com)

3. Living will should be legal and accepted. ---Dr. Hemang Koppikar, Mumbai
(hdkoppikar@gmail.com)

4. Living will or advanced medical directive needs to be encouraged. If an adult is

capable of making wills on a plain paper legally for his property ,and can make
decisions regarding organ donation in advance, why not living will. There can be
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 18

safeguards, like have a validity period of say 5-10 years, after which it needs to be
renewed for further periods. Witnesses like in the present way of making wills can
be provided. ---Murali Mohan V., Hyderabad (slnsp2003@yahoo.co.in)

F. Others

1. There should also be very strict punishment for all involved if the law is used for
material gains. ---Dr. Mahadev Desai , Ahmedabad (mahadevdesai@yahoo.com)

2. The courts also need to decide the case in a strict time frame of 15 days unless
medical advice / investigations are required. ---Santam Chakraborty, Mumbai
(drsantam@gmail.com)

3. If patient is in coma then the close relatives be given the right. ---Shyamsunder
Nikam, Amravati (shn01harrison@gmail.com)

4. No police involvement should be there. It should be between patient, relatives &

doctors ---Dr. G L verma, Jaipur (vermagldr@gmail.com)

5. There should be no scope for police involvement. Fool proof regulation is mandatory
to avoid harassment of doctors by police ---Dr. GL verma, Jaipur
(vermsgldr@gmail.com)

6. If the patient makes an informed consent to withdraw treatment but the relatives
persist towards continuing treatment - at that time if there is any aggression shown
towards the doctor by relatives, a means by which safety and protection of the
doctors from violence or aggression by relatives must be ensured. ---Dr. Jagdish
Chaturvedi , Bengaluru (dr.jagdishc@ymail.com)

7. Beforehand, patient's relatives' signatures should be taken not for permission but to
confirm that they know about the patient's decision. Because it is very common in
country like India to blame doctor for not being able to save a terminally ill patient
and mob, harrass or physically hurt the doctor. ---Aditya, Mangalore
(aditya7900@gmail.com)

8. Patients should be evaluated completely and consent should be sought from both
the family and the individual if in good mental health to become potential organ
donors. There are many conditions where all the organs are in good health but due
to disability the entire lifestyle is hampered such as in Paraplegics. This will not only
help another individual who wants to live and see another day but also give the
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 19

parents and relatives of the dying individual that there sons and daughters are alive
some where. ---Dr. Sumantra Saha (dr.sumantrasaha@live.in)

9. Introduce well structured palliative care training courses and practices in the country
which will make death much more comfortable and less painful. ---Dr. Aniket, Karad
(dr_aniket@rediffmail.com)

10. But good training for palliation essential to prevent misuse.Palliative training should
be in medical curriculum. ---Dr Tulika Seth, New Delhi (drtulikaseth@gmail.com)

11. Bill should be called "End of life care issues". The term Passive Euthanasia is
outdated, misnomer and misleading. ---Dr Hemang Koppikar , Mumbai
(hdkoppikar@gmail.com)
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 20

iv. Select quotes from Doctors on the Passive Euthanasia Bill:

If not life, let them at least choose death. ---Dr.archita j, Vadodara

Passive Euthanasia is a way to put an end to the agony and suffering faced by a terminally
ill patient and their family members. Letting such a patient live in a world of pain in the
name of humanity is simply cruel and punishing. ---Dr.Mahesh Rath, Bhubaneswar
(mahii1788@gmail.com)

Please bring the law as soon as possible because so many times we have witnessed
unnecessary prolongation of agony of the terminally ill patient in the ICU only to have
undignified death in the end and ruining the family financially and mentally. ---Dr Sandip
Bhattacharyya, Faridabad (sandipfbd2001@yahoo.co.in)

In case of incurable disease conditions, bed ridden person suffering from unbearable pain,
severe psychological and financial stress, keeping in mind the outcome of poor quality of
temporary bonus life, choice of euthanasia will be appropriate. Natural death is always
peaceful. ---Dr. Surekha Bangal , Loni (svb281@rediffmail. com)

There should be dignity in death. Life should not be more painful than death. ---Niharika
Ikkurthy, Guntur (niharika.ikkurthy@gmail.com)

If a patient is willing, knowing fully well that he or she may not get better, to withdraw
treatment, they should be allowed to do so. But as 'free will' is really not a thing, the bill
will need checks to make sure that the patient has full knowledge of the treatment options
available to him or her, is not withholding treatment due to financial constraints, and is not
being pressurised to take such a decision by external factors. ---Tanvi, New Delhi
(blackattanvi@gmail.com)

I am against the bill to be passed because it will lead to more criminal events than its use
for some (genuine cases) ---Animesh gupta, New Delhi (animesh6891@gmail.com)

We should try to empathize with the ones suffering from terminal conditions that they
can't recover from and put them out of their misery. As doctors it is our responsibility to
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 21

treat our patients but where ever not possible, we should let our patients decide what they
want. ---Mannat Narang, Amritsar (mannatnarang@gmail.com)

Its a tough situation. Doctors are already blamed for negligence, for no fault. Passive
euthanasia will complicate matters. ---Dr Rakesh Kumar Bhankurker, Sedam
(rakeshbhankur@gmail.com)

If it comes as a bill it may cause a lot of harm to the society. It can be and should be
mutually settled with the terminally ill patient or his or her family. ---Dr. Basab Mandal,
Kolkata (basabmm@gmail.com)

Euthanasia should be permitted but it should be clearly defined to a subset of patients. I

saw many of the head injury patients recovering after month to years in critical care
settings. ---Dr. Yashpal Singh, Varanasi (dryashacin1999@rediffmail.com)

I will accept this with (a) stoneheart. I will share my experience regarding this issue. I was in
my Internship period, posted in ICU. One elderly anaesthetist was admitted with diagnosis
of Parkinsonism and multiple organ failure on ET. Whenever I saw her pulse and BP, she
would ask me: why do you want to save me? (symbolically) If we do this, we can give them
peace in a different world. So i support this. ---Ganesan, Chennai (ganz256@gmail.com)

Then there will come a time where murder can be legalised. ---shravan, Bengaluru
(shravankumar342@gmail.com)

I am very afraid of misuse of this law ---Deepak shukla, Chandigarh

(dshukla.shukla4@gmail.com)

Patients will not be able to get palliative care ---Dr. Sushanta Bhattacharjee , Bongaigaon
(dr.sushantasmch@gmail.com)

Every living organism has the blessing of wilful death. The soul departs this earthly body
only when the desire to live ends and the inner heart/mind tells that let’s depart to the
place from where we have come. Thus it is my contention that the bill should be passed and
the natural death should be given a chance. It has been seen that in burns cases from
suicidal attempt, the recovery is poor whereas in cases of accidental burns cases, the
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 22

recovery has been good. It is the will power of the man which makes him to fight back the
illness and live. ---DR.SUBRAMANIAN R, Mumbai (drsubramanianr@gmail.com)

Being a doctor my first duty is to alleviate the pain or discomfort of my patient regardless
of the stage, even if it's the terminal stage. By discontinuing the treatment, patient will
eventually suffer and then die. Instead (I recommend) not to withdraw the basic treatment
and let the nature takes its own course. ---Sowmya K P, Bengaluru
(drsowmya10@gmail.com)

"Yavat kanth gatta praana yavat naasti niriindrya, tavat chikitsa kartavyasya kaalasya
kutila gati" meaning thereby "a doctor must do his duty to cure the patient till there is life
and senses are active as no one can predict how and when one will die" ---Dr Madan
Gulati, Chandigarh (vaidyamadan@gmail.com)

It is a doctor's duty to give treatment. I feel God works through doctors. Sometimes
miracles also happen. So I feel we can't withhold the treatment as long as the patient is
alive. ---Dr.A.Anitha, Tiruchirapalli (dranitha75@yahoo.com)

As a critical care doctor we have seen the pain of terminally ill patients. When they are on
ventilator and other invasive lines are used they are sedated to cope with the machines but
still they can feel the pain. ---Dr.kasturi bhagawati, Hyderabad (dr.bkasturi@gmail.com)

I support it since there is limited chance the body can survive against the will of the soul. ---
Dr. Bharath Kumar B, Bengaluru (drbharathkumarb@gmail.com)

Any laws brought about in this regard can be easily manipulated due to the subjective
nature of the patient's consent. It should be used to genuinely end the inhuman suffering
of patients beyond the scope of the best care, but can be used for other means. As long as
it is a well-supervised and stringent process to execute euthanasia, it should be a welcome
measure in advancing standards of Indian Healthcare. ---Dr. Pavan Madhukar Bhat,
Manipal (pavanbhat76@gmail.com)

Doctor is supposed to treat his patient till the end. He can not be playing the role of Dr.
Jekyll and Mr. Hyde. Nature will take its course despite the treatment. ---dr. atul shah,
Mumbai (atulshah08@gmail.com)
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 23

Yeah I object this with an opinion that the patient might have a perception in their mind
that now no more is left in their life which can save them, may be they are too depressed
due to their terminal illnesses that there is no hope left and in that condition, they do not
want to be offered any kind of treatment. However, being a doctor whose primary aim is to
heal and save lives, we cannot let the patient opt for this. It is very inhuman. Instead, we
should provide a counselling in that scenario to the patient and can make them understand
that we cannot leave all the things on nature and not all illnesses demand death at its first
place. Being a doctor, it's out foremost duty to save a life, I repeat. And not let them live on
their misery and opt for euthanasia. Thanks. ---Dr. Saroj Verma , Gurgaon
(dr.sarojverma1990@gmail.com)

We shouldn't forget what oath we have taken, when we became Doctors! ---Dr.
MOHAMMED SUHAIL K, Bengaluru (suhailk650@gmail.com)

If a person has made a decision when he is well enough to understand the significance of
prolonging life by supportive measures as and when he/ she falls ill, the sentiment should
be respected. The usual clinical scenario is an old couple living alone, children employed
and settled elsewhere developing a terminal illness with no chance of survival, and unable
to take own decisions is made to suffer longer by instituting futile treatment modalities.
This decision is made by the next of kin who rush in at the time and want "All the possible
treatment should be given". As per the present laws, the doctors are forced to undertake
the futile exercise which may prolong the life (and agony) by a few days or weeks. The new
Law if it comes into force will enable a person to decide on his treatment in case he
develops a terminal illness and prevent him from being subjected to procedures for just
prlolonging 'vegetative life'. This is my personal opinion. I have told my children that I
should not be put on ventilator or other life saving measures if there is no hope of good
recovery. ---Dr. R. Kasi Visweswaran, Trivandrum (rkasivis@yahoo.com)

Life is a gift of nature/creator and it should be enjoyed and respected. Extremely limited life
is neither enjoyed nor does it respect the person or the Creator. ---Dr Ajay Kapoor,
Guildford (kapoorap@gmail.com)

Extremely limited life is neither enjoyed nor does it respects the person or the creator.

It has a massive potential to be misused especially in our country where elderly are now
increasingly being neglected . More so because terminally ill will be left uncared for so that
they get depressed and chose euthanasia. Is it reasonable to believe that a country which
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 24

killed millions of its girl children has the collective sensibilities required for complex
decisions like passive euthanasia . In my opinion this will first be used against girl child as
parents will increasingly try to prove that the girl child is beyond treatment because even
without the law there are millions of girls who are anyways denied treatment just because
they are girls. ---Dr Sunil Moreker , Mumbai (morekersunil@gmail.com)"

One dictum which is to be followed in any terminal illness is that "Are you prolonging life or
death?" ---Dr Siddharth Agarwal, Agra (siddharthsatsangi@yahoo.com)
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 25

v. Recommendations Word Cloud

A summary of the words which came up most frequently in the recommendations and comments by
the respondents is depicted in the word cloud below. It is an interesting graphic that shows the
respondents’ key concerns and the key stakeholders in the debate.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 26

7. Conclusion

1a. A total of 956 doctors across India participated in the survey - of this 159 respondents
chose to share their views anonymously.

1b. Doctors across 57 specialties participated in the survey. General Medicine and Internal
Medicine was the most highly represented specialty with 132 respondents followed by
Anaesthesia and Critical care (63 respondents) and Paediatrics (47 respondents).

1c. A total of 211 cities were represented, with the top 5 cities being Mumbai (84), New
Delhi (76), Bengaluru (65), Hyderabad (38) and Ahmedabad (37).

1d. Respondents are evenly distributed across age-groups with the average age of
respondents being 40 years and median age being 35 years.

2. A large majority of doctors (91% i.e. 868 of 956 respondents) support the Passive
Euthanasia Bill.

3. The support trend (91% for, 9% against) is broadly similar across various segments like
age-groups, city and specialty with no unusual patterns.

4. Most doctors believe that if it is established without doubt that the patient is terminally
ill, suffering from pain, emotionally drained from his/her illness, and voluntarily chooses to
discontinue his/her treatment - then the same should be honoured.

5. The key reasons for favouring the bill include providing the patient a dignified death,
reducing physical, mental and financial suffering for the patient and family and providing
the patient "the right" to choose every aspect of his life, including when and how to die.

6. Almost all the doctors advise a high degree of caution in defining the key aspects of the
Bill: the definition of terminally ill, the emphasis on informed consent, and the constitution
of the committee formed to approve the request for Passive Euthanasia.

7. Doctors are hopeful that such legislation woould considerably help reduce the moral and
legal dilemmas faced by doctors in dealing with patients suffering from uncurable
conditions. However, they are also concerned that the legislation should not adversely
affect the same and that they do not become targets of harrassment by the police. To this
end, they recommend that the involvement of police needs to be strictly defined.

8. Key reasons cited by doctors who are against the Bill are: 1) It is the duty of the doctor to
treat till the last possible moment 2) the Bill has significant potential to be misused against
the patient and 3) the doctor can be subject to much controversy, litigation and harassment
if the Bill is passed
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 27

Appendix A: The Proposed Bill

The proposed Bill is attached separately along with the document. It may also be accessed
here: www.mohfw.nic.in/WriteReadData/l892s/44374928791462768288.pdf
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 28

Appendix B: Government Circular

The Government Circular inviting comments from the public is attached along with the
document. It may also be accessed here: http://www.mohfw.nic.in/showfile.php?lid=3865
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 29

Appendix C: PlexusMD Editorial

The PlexusMD Editorial on the subject, published on May 16, 2016 is attached along with
this document. It may also be accessed here: https://drive.google.com/open?id=0B-
ifQyfEttEQa2FEM1d6ek1EOU0
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 30

Appendix D: Survey Form

The Survey form used to receive Doctors’ feedback is attached along with the document. It
may also be accessed here:
https://docs.google.com/forms/d/11qZJlmrGCARVCFT7spWMJeLlf7xE80XX8g2z6GSZsHk/vie
wform
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 31

Appendix E: Responses

The raw copy of the responses received is attached along with this document.
Medical Treatment of Terminally Ill Patients Bill: Voice of Indian Doctors pg. 32

Appendix F: About PlexusMD

PlexusMD is India's leading professional network for doctors. PlexusMD helps doctors
collaborate with peers, stay updated and advance their careers and is now used by 50,000+
doctors and medical students and leading institutions like BMJ India, AIIMS, Columbia Asia,
Narayana Health, Manipal Hospitals and 300 others.

PlexusMD is the single-stop platform for breaking news in Medicine tracking developments
across 50 specialties and from 300+ sources, is India's largest doctor career platform with
over 500 live job listings and is India's only Medical events discovery platform.

PlexusMD was founded in August 2014 by Dr. Rohan Desai (MBBS, MBA - IIM Ahmedabad),
Dr. Binal Doshi (MBBS, MBA - IIM Kozhikode) and Kinnar Shah (B. Tech Comp. Sci., MBA -
SPJIMR Mumbai).

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