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All you need to know about living will for passive euthanasia

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Supreme Court of India

New Delhi: The Supreme Court in a landmark judgement on Friday recognised a terminally ill patient’s right to refuse medical treatment through an advance medical directive or a living will. Here are court laid down rules relating to the procedure for its execution.

*What is advance medical directive or living will?

It is a medical power of attorney that allows an individual to appoint a trusted person to take health care decisions when the patient is not able to take such decisions. The trusted person is allowed to interpret the patient’s decisions based on their mutual knowledge and understanding. The trusted person can decide on the patient’s behalf how long the medical treatment should continue when the patient in unconscious or in a coma state is not in a position to decide.

*Who is allowed to execute or draw up the will?

According to the Supreme Court rules, it can be executed only by an adult who is of a sound and healthy state of mind and in a position to communicate, relate and comprehend the purpose and consequences of executing the document.

It must be voluntarily executed and should have characteristics of an informed consent given without any undue influence or constraint.

It shall be stated clearly as to when medical treatment may be withdrawn or no specific medical treatment shall be given which will only have the effect of delaying the process of death that may otherwise cause the patient pain, anguish and suffering and further put him or her in a state of indignity.

In order to overcome the difficulty faced in case of patients who are unable to express their wishes at the time of taking the decision, the concept of advance medical directives emerged in various countries.

*What should the will speak about?

It should indicate the decision relating to the circumstances in which withholding or withdrawal of medical treatment can be resorted to.

Be in specific terms and the instructions must be absolutely clear and unambiguous.

Mention that the executor may revoke the instructions/authority at any time.

Disclose that the executor has understood the consequences of executing such a document.

Specify the name of a guardian or close relative who, in the event of the executor becoming incapable of taking decision at the relevant time, will be authorized to give consent to refuse or withdraw medical treatment in a manner consistent with the advance directive.

In the event that there is more than one valid living will, none of which have been revoked, the most recently signed advance directive will be considered as the last expression of the patient’s wishes and will be given effect to.

*How should the will be recorded, preserved?

The document should be signed by the executor in the presence of two attesting witnesses, preferably independent, and counter-signed the jurisdictional Judicial Magistrate of First Class (JMFC) so designated by the concerned district judge.

The JMFC shall preserve one copy of the document in his office, keep another in digital format, forward one copy of the document to the registry of the jurisdictional district court, inform the immediate family members of the executor.

A copy be handed over to the competent officer of the local body. A copy of the directive be handed over to the family physician, if any.

*When and by whom can it be given effect to?

In the event the executor becomes terminally ill and is undergoing prolonged medical treatment with no hope of recovery and cure of the ailment, the treating physician, when made aware about the advance directive, shall ascertain the genuineness and authenticity thereof from the jurisdictional JMFC before acting upon the same.

The document should be given effect to only after being fully satisfied that the executor is terminally ill and is undergoing prolonged treatment or is surviving on life support and that the illness of the executor is incurable or there is no hope of him/her being cured.

The physician or hospital where the executor has been admitted for medical treatment shall constitute a medical board that shall visit the patient and form an opinion whether to certify or not to certify carrying out the instructions of withdrawal or refusal of further medical treatment.

The Chairman of the board nominated by the collector, that is, the Chief District Medical Officer, shall convey the decision of the board to the jurisdictional JMFC before giving effect to the decision to withdraw the medical treatment administered to the patient.

The JMFC shall visit the patient at the earliest and, after examining all aspects, authorise the implementation of the decision of the board.

It will be open to the executor to revoke the document at any stage before it is acted upon and implemented.

What if the board refuses the permission?

If permission to withdraw medical treatment is refused by the Medical Board, it would be open to the patient or his family members or even the treating doctor or the hospital staff to approach the high court and its chief justice will have to constitute a division bench to decide upon case.

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India witnesses significant rise in dementia-related cases: Lancet

The results showed that the number of deaths from dementia has increased by 148 per cent over the same 26-year period.

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Moscow, Dec 12 : With number of individuals living with dementia increasing globally owing to ageing population, a Lancet study on Wednesday revealed that India witnessed a significant growth in the number of Alzheimer’s disease and other cases of dementia from 1990 till 2016.

According to the report published in Lancet Neurology journal, India witnessed nearly 2.9 million cases of Alzheimer’s disease and other cases of dementia in the 26-year period and nearly 1.4 lakh deaths arising from the problem.

The results showed that the number of people suffering from Alzheimer’s and other dementia increased from 20.2 million in 1990 to 43.8 million globally in 2016.

Of these, 27 million were women and 16.8 million were men.

To reach this conclusion, an international group of collaborating scientists, including HSE Professor Vasily Vlasov, analysed data from 195 countries on the spread of Alzheimer’s disease and other dementia between 1990 and 2016.

The results showed that the number of deaths from dementia has increased by 148 per cent over the same 26-year period.

Dementia is now the fifth most common cause of death worldwide and the second most common — after coronary heart disease — among people aged 70 or older, said the report.

Vlasov noted that according to the data, more than 1 million Russians — most over 50 — were suffering from dementia in 2016.

Researchers have linked high BMI, smoking (including all smoked tobacco products), and diet high in sugar-sweetened beverages as risk factors for dementia.

Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases, said the study.

“Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide,” it added.

There is growing evidence of risk factors for dementia, which shows that lifestyle and other interventions might, if implemented effectively, contribute to delaying the onset and reducing the future number of people who have dementia.

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Late childbirth linked to high breast cancer risk

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New York, Dec 11: Women who had their first child after 35 may be at an increased risk of developing breast cancer than their peers who do not have children, according to a study contrary to conventional wisdom that childbirth is protective against breast cancer.

Besides late childbirth, women who had a family history of breast cancer or who had a greater number of births also had an increased risk for breast cancer after childbirth. The pattern looked the same whether or not women breastfed.

While the risk was higher for women who were older at first birth, there was no increased risk of breast cancer after a recent birth for women who had their first child before 25, said researchers from the University of North Carolina (UNC) in the US.

“This is evidence of the fact that just as breast cancer risk factors for young women can differ from risk factors in older women, there are different types of breast cancer, and the risk factors for developing one type versus another can differ,” said Hazel B. Nichols, Professor at the UNC.

Although childbirth is still protective against breast cancer, researchers say it can take more than two decades for benefits to emerge.

Breast cancer is more common in older women, with the median age of 62 at diagnosis. But, the study, published in the Annals of Internal Medicine, identified elevated breast cancer risk after childbirth in women younger than 55.

In women 55 years and younger, breast cancer risk peaked about five years after they gave birth, with risk for mothers 80 per cent higher compared with women who did not gave birth.

Twenty-three years after giving birth, women saw their risk level off, and pregnancy started to become protective.

For their analysis, the team pooled data from 15 prospective studies from around the globe that included 889,944 women. In addition to looking at breast cancer risk after childbirth, they also evaluated the impact of other factors such as breastfeeding and a family history of breast cancer.

The findings could be used to develop better breast cancer risk prediction models to help inform screening decisions and prevention strategies, Nichols said.

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Fish oil reduces bleeding risk in surgery patients: Study

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New York, Dec 5: Fish oil, containing the omega-3s, lowers the risk of bleeding during surgery, say, researchers, challenging current recommendations to stop fish oil.

Fish oil is among the most common natural supplement for treatment of hypertriglyceridemia or prevention of cardiovascular disease.

However, concerns about theoretical bleeding risk have led to recommendations that patients should stop taking fish oil before surgery or delay in elective procedures for patients taking fish oil by some healthcare professionals.

The study, published in the journal Circulation, found that higher blood omega-3 levels — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — were associated with lower risk of bleeding.

For the study, 1,516 patients scheduled for cardiac surgery were randomised to omega-3s or placebo.

The dose was 6.5-8 grams of EPA+DHA over two-five days before surgery, and then 1.7 grams per day beginning the morning of surgery and continuing until discharge.

The findings showed that there was a significant reduction in the number of units of blood needed for transfusions.

In another analysis, the higher the blood EPA+DHA level on the morning of surgery, the lower the risk for bleeding, according to the Bleeding Academic Research Consortium (BARC) criteria.

“The researchers in this study concluded that these findings support the need to reconsider current recommendations to stop fish oil or delay procedures for people on fish oil before cardiac surgery,” said Bill Harris, Founder of OmegaQuant.

While Omega-3s, specifically EPA and DHA, are important for heart, brain, eye and joint health, most people do not get enough of these valuable fatty acids, which can increase their risk of the most serious health issues.

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