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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It shall be stated clearly as to when medical treatment may be withdrawn or no specific medical treatment shall be given which will only have the effect of delaying the process of death that may otherwise cause the patient pain,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.

IANS

Health

Diabetes could contribute to infertility, warn experts

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Diabetes

New Delhi, Feb 16: Diabetes, commonly described as a “lifestyle disease”, can contribute to infertility in both women and men, warn health experts.

“Diabetes can cause infertility in both men and women. Both sexes are at equal risk of infertility,” S.K. Wangnoo, endocrinologist at Indraprastha Apollo Hospitals, told IANS.

Infertility affects up to 15 per cent of reproductive-aged couples worldwide. According to an estimate by the World Health Organization (WHO), the overall prevalence of primary infertility in India is between 3.9 per cent to 16.8 per cent.

“Diabetes in men damages DNA of the sperm and leads to reduced number of sperms and reduced motility of sperms which leads to infertility. Although having diabetes does not necessarily make men infertile, it could make them less fertile,” added Roopak Wadhwa, Consultant at Fortis Hospital, New Delhi.

On the other hand, diabetes in women is associated with polycystic ovary syndrome (PCOS) and other autoimmune diseases that can lead to infertility.

“Diabetes causes a lack of glucose control in the body which, in turn, can make the implantation of the fertile egg in the uterus difficult. Therefore, the chances of miscarriage in diabetic women increase between 30-60 per cent,” Wadhwa explained.

Another WHO report had stated that India had 69.2 million people living with diabetes in 2015.

By 2030, nearly 98 million people in India may have Type-2 diabetes, according to a study published in the Lancet Diabetes and Endocrinology journal last year.

While diabetic patients can always try parenthood, the risk of passing on the sugar disease to the child is approximately 50 per cent high, Wangnoo stated.

“It can also cause intra-uterine growth retardation (IUGR) and congenital anomalies. IUGR is a condition where an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb,” Wadhwa added.

Furthermore, he noted that diabetic mothers are at high risk of premature deliveries, abortions and perinatal (during birth) complications.

High diabetes can be risky for both mother and child. The experts suggest that maintaining a good lifestyle, an ideal body weight, keeping sugars within target range, avoiding smoking and alcohol and excessive work related stress are some of the preventive measures.

Besides infertility, diabetes can also raise the risk of cardiovascular and lung disease, arthritis, osteoporosis. An estimated 3.4 million deaths are caused due to high blood sugar, according to the WHO.

The global health body also estimates that 80 per cent of diabetes deaths occur in low and middle-income countries and projects that such deaths will double between 2016 and 2030.

IANS

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Birth control pills could impair women’s ability to recognise emotion

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The study showed that healthy women who use birth control pills are poorer judges of subtle facial expressions than non-users. (Representative Photo)

London, Feb 12: Despite the widespread use of oral contraceptives (OCPs) by women, many are not aware that it may impair their ability to recognise others’ emotional expressions, which may have serious consequences in interpersonal contexts, suggests a new study.

The study showed that healthy women who use birth control pills are poorer judges of subtle facial expressions than non-users.

“More than 100 million women worldwide use oral contraceptives, but remarkably little is known about their effects on emotion, cognition and behaviour,” said senior author Alexander Lischke from the University of Greifswald in Germany.

“However, coincidental findings suggest that oral contraceptives impair the ability to recognise emotional expressions of others which could affect the way users initiate and maintain intimate relationships,” said Lischke.

To investigate the effects of OCPs on women’s emotion recognition, the researchers administered a special emotion recognition task to two similar groups of healthy women: 42 OCP users and 53 non-users.

The findings, published in Frontiers in Neuroscience, showed that OCP users were nearly 10 per cent less accurate on average than non-users in deciphering the most enigmatic emotional expressions.

Though the groups were equally good at recognising easy expressions, the OCP users were less likely to correctly identify difficult expressions, results showed.

The effect held for both positive and negative expressions, and regardless of the type of OCP or the menstrual cycle phase of non-users.

“Cyclic variations of estrogen and progesterone levels are known to affect women’s emotion recognition and influence activity and connections in associated brain regions. Since oral contraceptives work by suppressing estrogen and progesterone levels, it makes sense that oral contraceptives also affect women’s emotion recognition,” said Lischke.

There is a need for further studies that replicate and extend the findings of the present study before thinking about changing current guidelines regarding the prescription of OCPs, the study noted.

IANS

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The Delhi High Court seeks Delhi government response over bike ambulance controversy

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New Delhi, Feb 11 (IANS) The Delhi High Court on Monday asked the state government to file response to a plea alleging that trained paramedics are not deployed in bike ambulance service.

On February 7, the Central Accident and Trauma Services (CATS), an entity of the state government, launched a scheme of First Responder Vehicle, popularly known as bike ambulance service, to provide timely health assistance in traffic-congested areas and small lanes.

A bench of Chief Justice Rajendra Menon and Justice V. Kameswar Rao asked the Delhi government and CATS to file response on the plea seeking direction to deploy trained, young and energetic paramedics with requisite qualification and valid licence to drive two-wheelers.

The court has listed the matter for further hearing on May 2.

The court was hearing a plea filed by advocate Satakashi Verma and Kamlesh Kumar. In the plea, the advocates said that the scheme has been launched without doing due diligence with the help of untrained manpower, who are unfit to manage existing ambulance system due to lack of technical qualification.

The scheme was launched without deploying adequately qualified and trained paramedics, they added.

In their petition, they claimed that the existing staff of Assistant Ambulance Officer was found to be unfit for operation and maintenance of the bike ambulance service.

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