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It shall be stated clearly as to when medical treatment may be withdrawn or no specific medical treatment shall be given which will only have the effect of delaying the process of death that may otherwise cause the patient pain,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

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Health

High Vitamin D levels may reduce breast cancer risk

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vitamin D

New York, June 16: Higher levels of Vitamin D among women may reduce their risk of developing breast cancer post menopause, claimed a new study.

The study found that women with blood levels of serum 25-hydroxyvitamin D (OH) — the main form of vitamin D in blood — above 60 ng/ml (nanograms per millilitre) had one-fifth the risk of breast cancer compared to those with less than 20 ng/ml.

Thus, researchers from the University of California-San Diego determined that the minimum healthy level of 25(OH) in blood plasma should be 60 ng/ml, instead of the earlier recommended higher than the 20 ng/ml.

“Increasing Vitamin D blood levels substantially above 20 ng/ml appears to be important for the prevention of breast cancer,” said lead author Sharon McDonnell from GrassrootsHealth, a non-profit public health research organisation.

The study, published in the journal PLOS ONE, analysed data from two randomised clinical trials with 3,325 combined women and a prospective study involving 1,713 women with average age of 63.

Participants were free of cancer at enrollment and were followed for a mean period of four years. Vitamin D levels in blood were measured during study visits.

“This study was limited to postmenopausal breast cancer. Further research is needed on whether high 25(OH)D levels might prevent premenopausal breast cancer,” said Cedric F. Garland from UC-San Diego.

IANS

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Congenital Heart Disease Often Lead To Mental Illness

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WORLD HEART DAY

More than 1.5 lac infants are born in India annually with congenital heart disease. Around 78,000 infants die of congenital heart disease in India every year.

So What Is Congenital Heart Disease?

Congenital Heart Disease (CHD) is when a child is born with an abnormality in his/her heart. It could be abnormal in the way it’s structured (have parts of the organ missing, have functional problems and/or holes in the chambers. Doctors are often able to diagnose CHD while the child is still in the womb of the mother. CHD is considered to be a life threatening illness and hence can cause emotional turmoil in parents of the child, which in turn affects the psychological development of the unborn child.

Additional alterations immediately after birth for a child can prove to be traumatic, and cause PTSD like symptoms later on in life. For example, a child is often separated from the child’s mother and placed in intensive care immediately after birth, and then they are subjected to invasive medical procedures and tests. An infant with CHD goes through a traumatic event which is often reflected in feeding problems, nightmares and over all behavior of the infant.

According to Dr.Vihan Sanyal, psychotherapist, “Parents of children with CHD can seek the help of a skilled psychotherapist for their children’s psychological health while they are children. This will give the therapist to address the issue early on and help improve the quality of life of the child well into adulthood”

Early stressful experiences of a child can alter the child’s brain development, affect their immune system (the child tends to fall sick more often) and disturb the way a child reacts to stressful events in future life. Studies have proven that children who have been exposed to highly stressful environments early on in childhood often have issues with cognition and in processing of emotions.

Neonatal care, pediatric care, adolescent years and adulthood of a person diagnosed with CHD is often complex and challenging for the person. The psychological impact this creates is profound and can lead to suicide in adulthood if not managed properly.

Dr.Sanyal explains: “Children with CHD have difficulties with motor skills, speech, focus & attention, executive functioning, impulse control, management of emotions and behavior. The change in the structure of the brain and in brain chemistry can tarnish the image a child has of himself. He can quickly form an opinion of himself as being “abnormal”, leading to self esteem issues. It is important for children to be helped by a skilled psychotherapist, who is proficient in dealing with psychological issues of children living with CHD. Timely therapeutic intervention can provide the support a child requires in coping with the emotional challenges of CHD.”

Psychiatric disorders, in particular mood and anxiety disorders are more frequent in Adults with CHD compared to Non-CHD adults.

Life threat to the fetus is an important key factor for emotional disturbance during pregnancy for the parents. It is also an indication of long term psychological disorders faced by the parents of the child with CHD.

Studies have indicated that more than 30% of parents with children who have been diagnosed with CHD show signs of Post Traumatic Stress Disorder (PTSD). 50% of them have shown to have anxiety and depression. More than 80% of these parents have tested positive for psychological stress related disorders.

“MNLP & other modalities of psychotherapy can help the parents of those who have recently been diagnosed with CHD. MNLP can help in building resilience in the parents and equip them to face the challenges which lay ahead without disintegrating emotionally. Hypnotherapy can be used to promote relaxation and to address issues of trauma in the subconscious” Say’s Dr.Sanyal

Contributory Factors While Pregnant Which Can Result In CHD

· Smoking during pregnancy

· Consuming alcohol during pregnancy

· Exposure To Poor Air Quality (pollution)

· Exposure to Toxic Chemicals (Even common household chemicals like toilet cleaners and detergents)

· Exposure to pesticides and insecticides

· Medicines not meant to be consumed during pregnancy

· Obesity in mothers

In addition to the above list, symptoms of anxiety and depression in pregnant women often go undetected and hence, remain untreated. It is also important to mention that a range of symptoms of stress, anxiety and depression, marital harmony and quality of relationship the parents share with each other all have an effect on the fetus’s psychological health.

Dr.Sanyal says: “Many pregnant women of our country are unaware of some of the precautions they need to take during pregnancy. More importantly, they are unaware of the harmful effects the unborn child could face due to their habit and behavior. Many psychological disorders and mental illnesses can be prevented by pregnant women choosing to lead a balanced and a relatively stress free life during their pregnancy.”

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Health

Can sleeping more affect your heart?

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world sleep day

Seoul, June 13: If you thought that only less hours of sleep would affect your health, then you are wrong. Sleeping more than 10 hours per day is also associated with metabolic syndrome, raising the risk for heart diseases, according to a new study.

Those who slept for over 10 hours daily were at risk of elevated waist circumference, high triglyceride levels — a type of fat, low levels of “good” cholesterol, hypertension as well as high fasting blood sugar — referred to as metabolic syndrome and associated with increased risk of cardiovascular diseases.

While sleeping more raised triglycerides levels in both men and women, in women it led to higher waist circumference, blood sugar as well as lower levels of “good” cholesterol.

Conversely, getting less than six hours of sleep was associated with higher risk of metabolic syndrome in men and higher waist circumference among both men and women, researchers said.

“This is the largest study examining a dose-response association between sleep duration and metabolic syndrome and its components separately for men and women,” said lead author Claire E. Kim from Seoul National University College of Medicine in South Korea.

The study, published in the journal BMC Public Health, included data from 1,33,608 participants aged between 40-69 years. The results showed that the prevalence of metabolic syndrome was just over 29 per cent in men and 24.5 per cent in women.

“We observed a potential gender difference between sleep duration and metabolic syndrome, with an association between metabolic syndrome and long sleep in women and metabolic syndrome and short sleep in men,” said Kim.

IANS

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